A new health insurer in Maine hopes its unique approach will encourage primary care and lower costs

A new health insurer in Maine hopes its unique approach will encourage primary care and lower costs

Freelance bookkeeper Sara Ameigh of South Portland has never liked traditional health insurance.

"I felt like I was paying a ton of money, a few hundred dollars a month, and then nothing was covered at all," she says. "So it was like, what's the point of it? Why do I even need this?"

About five years ago, Ameigh discovered direct primary care, a model in which doctors forgo insurance and instead, charge a monthly membership fee for unlimited access. For $70 a month, Ameigh can call, text, or email her doctor whenever an issue crops up and get a fast response.

"I don't ever plan on leaving her," says Ameigh. "I never want to go back to the traditional model."

But on top of Ameigh's monthly fee, she also has to pay out of pocket for x-rays and labs, and she also pays for catastrophic health insurance.

A brand new insurance company on Maine's Affordable Care Act marketplace aims to simplify things for consumers like Ameigh by combining comprehensive health coverage and direct primary care into one plan. Taro Health is pledging that its plans will build a stronger doctor-patient relationship with minimal paperwork.

"These are physicians who kind of left the system, right, they don't accept any other insurance," says Taro Health co-founder Jeff Yuan. "And there's this opportunity, we feel to kind of rebuild the system, from the outside looking in."

Taro Health does offer traditional insurance, but its marquee plans are designed to work with the direct primary care model. The bet the company is making is that more access to primary care will prevent serious health issues, and therefore reduce overall costs. Taro is based in New York, but Yuan says it's launching its plans in Maine — solely in Cumberland County — because it has one of the highest per capita rates of direct primary care physicians in the country.

So why have these doctors — who had previously ditched insurance — now decided to link up with Taro?

"That's a great question. I'm asked that a lot," says Dr. Mike Ciampi.

He's operated a direct primary care practice in South Portland since 2014. He says he was so intrigued by Taro's commitment to collaborate with doctors that he chose to sit on its advisory board.

"I feel like I'd be a hypocrite saying we want to change the face of health care, and if an opportunity came to do just that, I want to be a part of it," Ciampi says. "And I want to be on the inside so I can help to guide it to do the right things if possible."

Dr. Lisa Lucas is also hopeful Taro will create a paradigm shift in health care. She says she spent several unsatisfying years treating a revolving door of patients in a traditional practice before she left to open a direct primary care office in Freeport. She hopes Taro will make it easier for other disillusioned doctors to take the leap.

"It's such a joy to be able to practice medicine this way," says Lucas. "And I hope that this at least provides, you know, some semblance of security for docs that want to leave the system and really want to practice in this way to just show them that it's possible."

Taro isn't the first insurance company that's attempted to disrupt the health care status quo. A start-up called Oscar launched a decade ago in New York with a focus on using technology to improve care and lower costs. Oscar attracted millions from investors and became publicly traded in 2021, but it hasn't turned a profit.

"There's often this idea that you can disrupt or revolutionize the health care system, but the health care system is very complicated," says Cynthia Cox of the Kaiser Family Foundation.

Cox says it's difficult for new insurers to find success in the marketplace. One major hurdle, she says, is raising enough investment capital. Taro has attracted investment from venture capital firms. And as it works to meet expectations of investors, doctors, and patients, Yuan insists that Taro will stay true to its mission.

"And it's our promise to the primary care physicians and others that we're going to try to make life easier for them so that they can spend their time with patients, not with us."

Taro's network includes about a dozen direct primary care doctors and MaineHealth. The average cost of their premiums is in the mid-range compared to others on the marketplace. Sara Ameigh enrolled in a direct primary care plan for $90 a month after subsidies. She says it's a huge savings compared to what she used to pay for health care. She's excited to start the new plan in January and hopes the model is sustainable.

"As an accountant, I'm a practical person," says Ameigh. "I'm like, I hope this business model is secure. But you know, I have faith in them."

Taro Health hopes after its first year to expand beyond Cumberland County and ultimately, into other states.

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