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Canopy Health to add UnitedHealthcare to unique provider-payer network in California

The health system pays the claims, accepts the risk of a health insurer, but does not sell coverage directly to consumers.

Susan Morse, Senior Editor

Canopy Health in California is about to pair up with another health insurer in an unique provider-payer partnership.

Effective Sept. 1, Canopy and UnitedHealthcare will cover patients in the Bay Area through the insurer's group coverage signature value plan.

Canopy is also awaiting pending approval to partner with Western Health Advantage in Sacramento, which will offer plans in the Bay Area, adding four counties to the provider's existing network.

[Also: Provider-sponsored plans carry on despite hefty losses]

In an unusual twist, Canopy pays the claims and takes the risk, according to spokeswoman Denise Vance-Rodrigues.

Canopy Health, owned by physicians and hospitals, technically owns a health plan, but it's license stops it from selling directly to consumers, she said.

"We own the risk for our members," she said. "Since we can't collect premiums, the premiums come to us and we pay it back. We pay it back to the carrier for them to manage."

Canopy has received a restricted Knox-Keene license from the California Department of Managed Health Care to operate in seven Bay Area counties.

[Also: Majority of provider-sponsored plans losing money, report says]

It accept responsibility for the full medical costs and quality management of health plan enrollees, but it is not an accountable care organization.

Unlike Kaiser Permanente, which Vance-Rodrigues said comes the closest to the Canopy model, physicians are not employees. Canopy is owned by the physicians and hospitals. These include UCSF Health, John Muir Health, Muir Medical Group IPA, Hill Physicians Medical Group, and Meritage Medical Network.

It launched its insurance product in 2016 with Health Net and one employer.

The provider-plan alliance is currently composed of nearly 4,000 providers, 15 hospitals, and numerous care centers across the seven counties.

Primary care physicians may refer a patient to any specialist within the system to stay in network.

Canopy is also launching a transparency app to let patients know what their costs are going to be, based on their plans' high and low estimates.

The healthy system is also working on a project to align electronic health records.

The system wants to grow slowly, Vance-Rodrigues said. It has a goal of adding 200,000 members over the next four years.

Twitter: @SusanJMorse
Email the writer: susan.morse@himssmedia.com

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