Clay Johnston, the first dean of the University of Texas Dell Medical School, could have retired or gone to work at another university. Instead, he’s helping to launch a different model of primary medical care with Harbor Health.
Johnston stepped down from Dell Medical School in September 2021, after leading the school since January 2014. The school just named its second dean, Dr. Claudia F. Lucchinetti from the Mayo Clinic in Rochester, Minnesota. She will start Dec. 1.
Harbor Health, which has both pediatric and adult primary care physicians, has opened two locations, one in Round Rock and one in Central Austin. It has more planned for Kyle and other Austin neighborhoods as well as mobile clinics with one or two exam rooms each.
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The concept of Harbor Health is really an extension of what Johnston was working on at the medical school to improve patient care while improving the cost of care, he said. “How can we better align with society’s interests; how can we create a whole system of keeping people healthy?” he said.
Dell Medical School has been working in its specialty care clinics at UT Health Austin to get insurance companies to pay one price per patient for their yearly care.
If a patient was seeing a specialist about a knee replacement, UT Health Austin wanted insurance companies to pay one annual fee to cover all the care the doctors and therapists working with that patient would provide throughout the whole process rather than billing for each event. It was very similar to the way insurance and the patient might pay an obstetrician one fee for the whole pregnancy, instead of doing a co-pay and insurance charge for every visit and every billable event.
Dell Medical School was working on “reducing waste in the system, and there’s a ton of waste,” Johnston said. “We were able to show we could do it. … That should have been a huge experience.”
The insurance companies, though, didn’t buy in, Johnston said. “We wanted them to pay us for results,” he said, instead of per-item fees. “They just wouldn’t do it. … We just kept running into walls.”
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Dell Medical School also looked at expanding care into primary care in this way, not just specialty, he said, but that’s typically not where medical schools spend their energy, and a consultant strongly encouraged the school to not go that route, Johnston said.
Johnston said he realized about three years ago that this changing of the way health specialty care is billed and paid for by insurance wasn’t catching on at the medical school, and Dell Medical School didn’t have a way to scale it up, he said.
What he did have is one insurance company that was really interested in what Dell Medical School was trying to do. That was Bind Insurance from Indiana, and its founder, Tony Miller. Bind was rating the care doctors provided and charging patients more if they saw a doctor with not as good outcomes than if they saw a doctor with better outcomes.
Miller has since sold that insurance company and Harbor Health as its CEO with Johnston as its chief medical officer.
Like what Dell Medical School has tried to do with specialty care, Harbor Health wants to change the way insurance companies pay for primary care as well as change the primary care experience.
“We’re in it to disrupt the system,” Johnston said. “The health system has gone off the rails.”
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Harbor Health is working with insurance companies to get them to pay Harbor Health what they typically pay for care for each person a year. Harbor Health will then take that money and provide as much care as a patient needs as well as connecting patients with specialists who are either part of Harbor Health or in outside practice groups, but are recommended by Harbor Health based on their known outcomes.
“I don’t play golf or drink Scotch, but if I did, I still wouldn’t be choosing these doctors based on this,” Johnston said. “We’re getting a commitment from them to practice in a certain way.”
Patients will have as much access to their care team as they want, including through text messages, calls, extended hours and Saturday hours.
Johnston likens the experience trying to get a pediatrician on the phone to talk about a child’s stomach pain. Not being able to, a family might end up in the emergency room, paying for imaging and for emergency room and doctor fees for what is constipation.
“Getting access to a pediatrician should be simple,” he said. That should include texting the doctor a question and getting an answer, he said.
A Harbor Health care team includes a primary doctor, a health guide to help patients navigate their health care, and a nurse. That primary care team will consult with specialists and bring them into the team, which might not require a separate visit by the patient to that specialist, if the primary care team can manage based on the specialist’s recommendations.
“We’re trying to do this differently,” Johnston said. “We’re trying to be responsive and cost-effective.”
That means focusing on preventative care and taking time with patients. Johnston said, Harbor Health doctors might spend an hour working with a patient instead of the 15 or 20 minutes most primary care doctors allot.
Harbor Health is a for-profit company. It intends to make money by receiving the same fee for each patient each year and saving the patient unnecessary hospital visits and other medical expenses by focusing on early and preventative care to improve their health.
Harbor Health is starting in Austin first, but Johnston wants to be able to grow across Texas and then the country.
“For me, I want to see the job done,” he said. “I’m in it until we’ve gotten to the point where it’s making a difference across the country.”
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