James Maskell and the Intriguing Incenticare Insurance Model for Access and Payment for Functional and Integrative Care

James Maskell and the Intriguing Incenticare Insurance Model for Access and Payment for Functional and Integrative Care

The co-founder of the Evolution of Medicine/Functional Forum, James Maskell, is a non-stop communicator and marketeer. He operates at the visionary edges of the integrative and functional medicine worlds. Business success. Health coaching. Blue Zones and zip-codes. Root-causes. The employer stakeholder. The “micropractice.”

Lately, the incoming tide of Maskell’s mailings is laden with introduction to an insurance product called Incenticare® from the Benicomp Insurance Company. Like other integrative health business products that Maskell champions, Incenticare® is exuberantly positioned as an answer to critical needs.

There is much here to intrigue one. The product hits all the right notes: employer focus, use of coaches, incentives for reversing disease, decent physician fees, plus opening of access to those less served by functional medicine. I listened to a Maskell podcast with Benicomp executive Doug Short then contacted Maskell and Jeff Gladd, MD. Gladd serves as medical director for the entity. Knew Health, through which Maskell is promoting Incenticare on a 22 city tour this summer.

Before the tour ends, Maskell hopes to have worked through local functional/integrative doctors to create Incenticare contracts with multiple self-insured employers across the country. His goal is have in place by January 2019 a preferred provider organization (PPO) of functional medicine doctors making up to $300/hour for their roles in serving at least 5,000 employees in Knew’s health coach-centric Incenticare® product.

Maskell’s connection with Benicomp came through Gladd, a 2009 fellow of the University of Arizona Fellowship in Integrative Medicine. Gladd has since taught business courses there and for the fellowship at the Academy of Integrative Health and Medicine. His business pedigree is 8-years of what he characterized as a “wildly successful” functional medicine practice in Fort Wayne, Indiana, GladdMD Integrative Medicine.

Among Gladd’s patients were multiple Benicomp executives, “some for preventive and others root cause issues.” They learned how functional and integrative medicine practitioners work with lifestyle changes to reverse chronic disease.  They began to cook up their idea of an “integrated wellness insurance program” with virtual health coaches, backed by a PPO of integrative or functional medicine doctors.

The product Knew Health is offering is effectively Incenticare 2.0. Incenticare 1.0 was first developed by Benicomp’s Short and other members of their team in the Bush era of rising expectations for Health Savings Accounts and other more individualistic responses to the need to reform the US medical industry. Incenticare 1.0, as Short shares in the podcast, came prior to passage of the Affordable Care Act and expectations of many that the US was moving toward single payer. Now the Republican policies to gut or swiss-cheese Obamacare, plus the Benicomp executives’ connection with Gladd, stimulated the insurer to bring the program back to life.

Gladd explains that in the Incenticare model, each employee has “skin in the game.” Benicomp secured governmental approval to offer employees different levels of deductibles based on their individual health status. Thus an individual “could save as much as $3,000 a year” by being low risk, or by lowering risk through enhancing their health.

Benicomp also has skin in the game – its own incentives to promote health. By helping its policy holders to make positive changes, Benicomp recoups part of the reduction in an employer’s medical expenditures through a shared savings model.

Gladd explains that the employee’s incentive to pay lower their deductible drives participation in screening and blood testing that finds those at most risk. As high as 97% do. If participation reaches 70% – many reach no more than 30% and self-select for the healthy – the employer’s ability to discover high-risk employees and enroll them in health promoting programs goes up dramatically.

This is where the work begins for Gladd and his Knew Health team. First, employees are stratified into three groups:

  • the top tier is basically healthy individuals
  • a middle tier has indications of potential health decline, and
  • the bottom has frank, chronic health problems.

Those in the bottom are those that would be seen by a functional or integrative medicine doctor who has been credentialed into Knew Health’s preferred provider organization (PPO) that Gladd, Maskell and the 22-city tour are helping build.

At the center of the Knew Health model are well-trained, medically overseen health coaches led by Gladd’s partner in selecting, training and managing them, Tracy Harrison, Knew Health’s Director of Coaches. These work virtually, managing the middle strata of patients. They also help identify and triage those employees who need more medical care to the PPO’s doctors “based on protocols Tracy and I have developed.”

A key Knew Health guideline for selecting and credentialing functional practitioners for the PPO network is to find those whose focus is rooted in helping the employees make lifestyle changes “rather than expensive testing and a lot of supplements.”

Knew Health is incented to get as much care as possible through its coaches. For starters the functional PPO membership will be limited to functional/integrative MDs, DOs and nurse practitioners. Maskell said they are considering potentially expanding to appropriately trained NDs and PAs.

The local PPO networks will be built-on-demand. The first step is getting employers to contract for Incenticare©. Maskell anticipates that doctors in the EvoMed network will be bridges to executives and decision-makers for corporations in their cities. Build your practice by helping sign up an employer. More skin in the game.

Gladd reflects on the fee level Benicomp will pay the PPO doctors: “The $300 per hour may not be enough for a person with a well-established functional practice, unless the doctor wants to be open to more people having access.” He expects many who are starting out in practice will be. He also underscores that Knew Health is seeking to manage the “practice pain” out if it, for the doctors. For instance, on enrollment, the employees will fill out “something equivalent to” the Institute for Functional Medicine’s lengthy screening tool.

The program has characteristics recommended by actuary Ken Beckman in An Actuary’s Proposal for Business Success for Lifestyle Medicine Practices. The “Actuarial Patient Value Model” developed by the economic committee leader at the American College of Lifestyle Medicine is also employer-based and incented via shared savings.

A difference is that the Knew Health model is not pie in the sky. In fact, Gladd, Harrison and Knew Health’s half-dozen coaches are set to begin their first client, an automobile sales company. Maskell shares that a surprisingly high percent of the employees fell into the second and third strata. Those in the former set up the need for the coaches. Those in the latter will start with coaching and be appropriately referred to Knew Health’s first PPO network of lifestyle-oriented functional or integrative doctors.

If all goes as planned, the first adopting employer should be quite happy. Data provided by Benicomp on this website suggests that a typical employer with a medical tab of $4-million per year can anticipate saving nearly $5-million over a five year period, nearly 25% of premium costs. A firm with a risky employee population, like the automotive client, would be expected to save even more.

Meantime, critical to what some have called the imperative for health justice in the typically cash-based integrative medicine world, employees who couldn’t have afforded these services can through this insurance product have access.

While Gladd is busy tweaking the model, Maskell will spend the next four months on a 22-city tour to build excitement for the Knew Health plan. Maskell’s goal in the ambitious road show is to drive interest of coaches and functional and integrative medicine practitioners and, through them, find contracting employers.

Maskell doesn’t expect troubles finding practitioners. EvoMed’s announcements have shown interest from over 600 functional practitioners and roughly 1200 coaches “have come to the site.”

The proof for the program will be in the recruitment of employer partners. Knew Health’s goal is 5,000 employees in the program by January 1, 2019. Maskell is all in on this. He and his colleagues are finishing one round of financing for EvoMed and Knew Health. They are already anticipating a new, larger round that might support this and other Knew Health plans.  Maskell is laying it all on the line to realize his exuberantly expressed goals for flourishing functional-integrative communities of practitioners.