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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, several hundred dollars a month, and then nothing was covered,” she says. “So it was like, what’s the point of it? Why do I need it?”

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, Ameig can call, text or email her doctor when a problem arises and get a quick answer.

“I never plan to leave her,” says Ameigh. “I never want to go back to the traditional model.”

But on top of Ameig’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 promises that its plans will build a stronger doctor-patient relationship with minimal paperwork.

“These are doctors who kind of leave the system, right, they don’t accept any other insurance,” says Taro Health co-founder Jeff Yuan. “And there is this opportunity, we feel, to rebuild the system, to look in from the outside.”

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, thus reducing overall costs. Taro is based in New York, but Yuan says it is starting its plans in Maine — only 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 previously dropped insurance – now decided to link up with Taro?

“That’s a great question. I get asked it a lot,” says dr. Mike Ciampi.

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

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

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

“It is such a joy to be able to practice medicine in this way,” says Lucas. “And I hope that it provides at least some security for doctors who want to leave the system and really want to practice in this way, just to show them that it’s possible.”

Taro isn’t the first insurance company to try to disrupt the health care status quo. A startup 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 went public in 2021, but it did not turn 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 is difficult for new insurers to find success in the market. One major obstacle, she says, is raising enough investment capital. Taro attracted investments from venture capital firms. And as it works to meet the expectations of investors, doctors and patients, Yuan insists Taro will stay true to its mission.

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

Taro’s network includes about a dozen direct primary care physicians and MaineHealth. The average cost of their premiums is in the middle range compared to others on the market. Sara Ameigh signed up for a direct primary care plan for $90 a month after subsidies. She says this is a huge savings compared to what she used to pay for health care. She is excited to start the new plan in January and hopes the model is sustainable.

“As an accountant, I am a practical person,” says Ameigh. “I’m like, I hope this business model is safe. But you know, I have faith in them.”

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

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