Allies HMO: a new kind of health experience

As part of our Roadmap 2020 campaign, AllWays Health Partners introduced our Allies HMO, an innovative new product designed to make high-quality care more affordable and accessible. What makes Allies unique in the market? It was developed in partnership with Newton-Wellesley Hospital. We spoke to Rebecca Robak, Manager of Product Strategy and Innovation, about what it was like creating a health insurance product in collaboration with providers. 

Q: Allies is a true collaboration between AllWays Health Partners and Newton-Wellesley Hospital. This hadn't been done before. What was the development process like?

A:The first thing we did was meet with physicians and administrative leaders at Newton-Wellesley to begin collaborating about what we could do. We wanted to make sure we were developing something that would appeal to our members and the hospital. For example, the team at Newton-Wellesley was very interested in the virtual care aspect. And although we wanted to support a Virtual Health primary care practice, we also wanted to attract members who might not want a virtual experience. Our solution: we decided to include the Virtual Health practice and expand the PCPs in the network to include all the providers affiliated with Newton-Wellesley Hospital.

Q: How did collaborating with providers change the typical product development process? What insights did you gain from the unique relationship?

A: The standard part of a product is its benefits and network. Developing those aspects were consistent with what we typically experience. The difference was in developing the unique features of the consumer experience. We collaborated with providers to figure out what would work and what made sense. For example, Allies HMO offers improved access to certain specialists with a three-day turnaround time. We spoke to physicians about what specialty groups would be interested in providing that and worked with the hospital to determine what kind of turnaround time made sense. We also looked at how we could make referrals to these provider groups part of their normal referral process. Assimilating physician and hospital input helped us develop different features that improve the member experience and could be easily supported by the providers. This was in comparison to what we would have considered a straight insurance product.

The Allies Health Navigator role was also a unique facet of development. The position was created initially as a bridge between our two organizations. But, as we continued developing the Allies experience, we uncovered additional things that the Health Navigator could do to make things easier for the member. The physicians suggested several of these ideas based on their understanding of patients' care experience.

Q:What kinds of things will the Allies Health Navigator do?

A:As an example, the Health Navigator will be able to help members schedule appointments. Suppose a provider wants a member to see a particular specialist. In that case, the Navigator has the contacts set up within the provider groups to schedule that appointment. They'll also help with the transition of care after a member is discharged from the hospital by reaching out to them and helping them schedule any necessary follow-up appointments. The Navigator is currently meeting with many of the network practices to understand who the key contacts are. By building those relationships, they'll be a resource to help members select PCPs and navigate the system. Generally, Navigators are usually focused more on the insurance side or on the clinical side. Our Allies Health Navigator is a bridge between both.

Q: What else is unique about Allies HMO?

A:Our primary focus is on the consumer experience and ways to make things easier for them with resources like virtual care and the Health Navigator position. Although we started developing Allies HMO before the pandemic and before telehealth took off—we always intended to use virtual care as a means of convenience for those who prefer it.

As mentioned earlier, we also worked with physicians to ensure everything would fit in with their practice. Rather than asking them to change their processes, we built our operations on top of their existing procedures. For example, we modified the referral screen in EPIC for Allies HMO patients, making it easier for providers to navigate. We know it's not easy to change PCPs, so we worked on making this easier for the patient. To make the enrollment process simple, sales specialists are there for people to answer all of their questions. Since we're still starting out and building up our membership, our Navigator reaches out to personally welcome each new member. We also want to be seen as innovators in the community, so our Navigator role and Newton Wellesley’s Virtual Health primary care practice are ways for us to do that.

We're still a bit early in the product roadmap to say where things will evolve. We're still waiting to hear from patients about what they'd like to see and what we can do next. We're also trying to improve communication between AllWays Health Partners and Mass General Brigham by creating a single sign-on from the patient portal of Mass General Brigham to the AllWays Health Partners member portal. As we work with the Mass General Brigham team, we're finding more things that we can do to improve the flow of information between the insurer and the health system itself.

Q: Were there any lessons that you learned throughout this process?

A: COVID-19 hit as we were developing the product, so our ability to meet with the Newton-Wellesley providers was limited. They were able to have one of their providers and a business person be our point people. Those two became our team, and they'd reach out to the other providers we were working with. This wasn't a standard way to work, but we kept the project's momentum, which speaks to both organizations' commitment to this project. We are identifying what worked well in this collaboration and where we can improve. And we're excited to do this with other health systems and bring that knowledge and experience to our next development.