When the nation’s largest health insurer announced Tuesday it will cut its losses and reduce its exposure to Obamacare insurance exchanges to just a few states in 2017, it was a sign of the fragility of the healthcare marketplaces, where some insurers are struggling to make money.

Fearing massive financial losses, UnitedHealth Group said it would sell health policies on exchanges in only “a handful” of the 34 states it did in 2016. But there was one notable exception.

When UnitedHealth pulls out of Georgia in 2017 it will leave one of its insurers untouched: Harken Health, which sells plans in Atlanta. It may be a small company, with a small pool of patients, but observers say it also contains clues for how to succeed in a cutthroat and challenging post-Obamacare world. It’s a good thing United left Harken Health behind, they say, because someday, it could prove to be the kind of Obamacare success story that, for now, is rare.

“It’ll be very interesting for us to see what will happen with Harken,” said Dustin Eggers, a principal at DRG Consulting in Chicago. Harken serves a mix of different kinds of patients, but it does so in an unorthodox way: Patients fall under the charge of a dedicated "care team," for instance, and have unlimited, free primary care visits. “If that doesn’t work for the exchange population, I don’t know what will,” Eggers said.

Harken Health began as a partnership between Boston-based Iora Health and Minnesota-based UnitedHealth Group, which has invested $65 million in the independent subsidiary. In January, Harken began operating six clinics in Atlanta and four in Chicago and now serves approximately 35,000 patients.

 

What distinguishes Harken from other health insurers? According to the company, it's the way it creates relationships between doctors and patients. Harken offers free primary care in the form of “unlimited visits to our new and inviting Harken Health Centers,” plus a care team that promises to “know your story, not just your symptoms,” and is available 24/7 by phone, email or video chat, when not available in person. Doctors are part of that team, as are health coaches and behavioral health specialists. Clinics offer yoga, cooking classes and even acupuncture. And in a major departure from other insurers, Harken pays its doctors salaries, not fees tied to the number of patients seen, or tests ordered.

But Harken’s approach is a gamble. The amount it spends on primary care is double that of the average insurer, Kaiser Health News has reported. If Harken Health is to see financial payoffs, they’ll likely come about in the long run, not immediately, because it could take years, even decades, for those weekly yoga classes and cooking classes to result in one's not developing diabetes.

“It’s reasonably proven that if you overinvest in primary care, you have lower downstream cost in the system,” Harken CEO Tom Vanderheyden once told Modern Healthcare.

If there’s any assurance that Harken’s idea will work, it may be found in Kaiser Permanente, the well-regarded California-based nonprofit that is a tightly knit system of insurance and doctors, clinics and hospitals. Kaiser Permanente got started in the mid-1940s, and as with Harken, doctors are paid a fixed fee for patients that helps keeps costs low. Advocates of Kaiser's model have praised it for decades, such as in this New York Times article from 1989, "Why Kaiser is Still the King."

Kaiser Permanente’s model is not without its flaws, of course. It has received criticism for long wait times for mental health services, for example, and its membership in 2013 was no higher than at its 1998 peak. In 2015, its profits fell nearly 40 percent, a drop that corporate treasurer Tom Meier blamed on a poor return on investments (operating revenue that year grew 7.6 percent to $60.7 billion).

But as health insurers struggle with financial losses, and blame those losses on Obamacare patients whom they characterize as especially sick and therefore expensive, they may also welcome a possible solution that improves upon the status quo.

“Harken is a small and interesting innovation that we are considering, and we will stay with it,” UnitedHealth Group CEO Stephen Hemsley told analysts on an earnings call Tuesday. “It's in a very modest pilot position,” he added. UnitedHealth reported losses of $475 million on Obamacare exchanges in 2015, and could lose half a billion in 2016.

“Maybe Harken is being left there to see how it does,” Eggers said. If it eventually produces the return on investment that UnitedHealth needs to placate shareholders, maybe Harken will become the brand for UnitedHealth exchange products, he suggested.

As for Harken’s future, the company appears to be moving forward one step at a time. CEO Vanderheyden said in an interview in March with the Minneapolis Star-Tribune that the company plans to expand in 2017, but he did not offer more details.