New Health Insurer Rewards Patients Who Stay Healthy

Cheryl Clark, for HealthLeaders Media , September 15, 2009

Imagine buying a health insurance policy for your employees that rewards not the provider for giving good care, but your workers for taking steps to stay healthy.

And if do three things: Make and keep preventive care appointments with their physicians, attend proscribed "wellness fares," and register with an online tool and fill out an electronic health record, they pay lower deductibles and lower copayments.

Welcome to SeeChange Health. The company based in San Francisco is awaiting approval from the state Department of Insurance, but expects to begin selling policies to employers with between 20 and 50 employees starting Sept. 29.

"Our business premise is that traditional insurance companies have focused on the wrong things," says SeeChange CEO Martin Watson. "They only worry about their members after they come down with a chronic illness."

And, he continues, "Most insurance companies have structured their models in such a way that they don't want you to see a doctor. They design complicated products that result in low claims. And you'll be dissatisfied with them and leave. And by the time you have a chronic problem, you will be another carrier's problem."

Watson says the company will begin selling the policies to employers in Fresno, and already has agreements with Community Health Centers and Santé Community Physicians, and a network of 2,800 doctors. "Then we'll be moving into the mid-central Valley, then to Bakersfield, and then Los Angeles and San Francisco in rapid fashion. And to Colorado next year."

Watson says the idea with SeeChange is to find problems early to get them managed when their conditions are more inexpensively controlled, rather than wait until conditions worsen.

Initially, enrollees will have a 70%-30% plan in which SeeChange will pay 70%, along with a $2,000 deductible.

"But when a member completes those three things, the plan changes to 80%-20%, and the deductible drops to $1,000." And if through the process a disease is diagnosed, out-of-pocket expenses will be waived.

"Here's where we're greedy capitalists," Watson says. "We know that the medical cost with say stage one diabetes is much less than a stage three. We know we can save a lot of money if we can keep you at stage one."

Watson says his company is adequately capitalized with $40 million, and has an expanding number of provider contracts.

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