A Win-Win Scenario

Some partnerships don’t just make for good business; they also make perfect sense.

Health First Health Plans of Brevard County and Florida Hospital Healthcare System (FHHS) recently agreed to the kind of deal that will have a major impact on health insurance plan offerings across as many as 10 Central Florida counties.

With a 4.5-star rated Medicare Advantage plan, Health First Health Plans has more than 60,000 members and is Central Florida’s only fully-integrated health system with four hospitals — Holmes Regional, Viera Hospital, Palm Bay Hospital and Cape Canaveral Hospital — to serve its clients.

Florida Hospital Healthcare System is Florida Hospital’s administrator for employee health insurance. Its network extends through Orange, Osceola, Seminole, Volusia, Flagler, Highlands, Hardee, Hillsborough, Pasco and Pinellas counties with 23 hospitals, 22 urgent-care centers and more than 4,000 physicians.

Playing to their Strength

The partnership between the two is expected to lead to more options for Medicare patients, while also providing cheaper health plans for businesses. Enrollment for Volusia and Flagler counties began October 15, with a three-to-five year rollout plan that will eventually reach from Brevard County to Daytona Beach, Orlando and Tampa.

“By taking the proven experience, quality, and valuable benefits Health First Health Plans has shown for more than 15 years and combining that with the well-respected and trusted name of Florida Hospital, we will be able to provide high-quality care the residents of Volusia and Flagler counties have come to know at Florida Hospital,” Health First CEO and President Steve Johnson commented.

Part of the beauty of the partnership is that it will allow each organization to play to its own strengths, while providing a big benefit to clients. “We will be providing what is called a ‘private label product’ for Florida Hospital Healthcare System,” Johnson explained. “They will provide their excellent clinical resources in the form of physicians, hospitals, patient facilities, etc., and we will manage that care through our health plan. The plan will be called Florida Hospital Care Advantage, administered by Health First Health Plans.

What Is the Impact?

How will this affect Medicare patients? Johnson stated that Volusia and Flagler County residents who sign up for the new Medicare Advantage plans will receive a high-quality healthcare insurance plan delivered by a nationally-recognized health care system that is focused on providing a streamlined team approach with comprehensive benefits. The user-friendly health plan will be led and delivered locally and will include a variety of providers that will be easily accessible through an open access system.

It should also be a boon to local businesses, both large and small, that are looking for the best type of health coverage plan for their employees. In that regard, it’s the same type of benefit Health First has always tried to provide for its clients.

“Health First Health Plans is continuously improving our products and selections,” Johnson said. “Beginning this year, we have offered a new Group PPO product, which is ideal for small businesses as we enter the new era of health care. “It is our goal to provide similar products to the areas that Florida Hospital Healthcare System serves.”

Mike Schultz, president and CEO of the Adventist Health System Florida Region highlighted one of the primary benefits of the alliance. He said it helps create a financial incentive for Florida Hospital to reduce admissions and cut down on things like emergency room utilization, since they are not only a provider of medical services but will be a payer as well. “That’s why we want to get on the payer side of the business, so we’re incentivized to do those things,” Schultz said.

Benefits to Brevard

Johnson, who came on board as Health First’s CEO and president in September 2011, said he had always been interested in expanding the company’s base; it was just a matter of finding the right partner. “When I began looking at Health First as a possibility of becoming the CEO, I was impressed with all of the different businesses and assets that had been created by the previous leadership,” Johnson said. “Their vision to create a health plan was one that is desired by nonprofits across the country.

“After speaking with Health First’s board of trustees, we realized that it was an asset that we could expand across the state to help bring revenue back to Brevard County, so that we could continue to reinvest in our community. Therefore, I began the process of working with several health systems across the state to determine which would be the best fit for us and for them.

“In the end, with the help of President and CEO of the Adventist Health System Florida Region, Mike Schultz, we realized this mutually beneficial partnership was the best option for both of us. Those discussions have been ongoing for about a year now.”

Ultimately, the real benefit of any good health care plan is the ability to give patients high-quality treatment at a reasonable price. The new Florida Hospital Care Advantage, administered by Health First Health Plans figures to do just that.

Integration & Coordination

By working toward the top 10 percent of nationally-recognized integrated delivery networks, the partnership will be able to ensure its members not only receive the right kind of care, but its system of checks and balances will prevent duplicate medical tests and as a result eliminate unneeded processes and waste.

In doing that, Johnson said the goal is to be able to return some of the savings in the form of competitive premiums while still being able to enhance the quality of care for all. “As Health First continues to evolve into an integrated delivery network, we have recognized that our health plan is the integrator and coordinator of care,” Johnson emphasized. “From prevention and wellness to acute care to post-acute care, Health First Health Plans has the ability to manage care and members’ health, which are paramount for our success.

“Health First Health Plans will be able to accomplish this same task for Florida Hospital Care Advantage members, meaning they will be able to assist with ensuring Health Plan members in Volusia and Flagler counties also receive the right care, at the right place, at the right time.”

Combining a hospital with a health insurance plan is hardly new. In fact, the perfect model would be Kaiser Permanente in California, which opened as a hospital in the 1930s and now boasts 8.9 million health plan members.

“Kaiser Permanente was building the future of health services before anyone realized it,” Johnson explained. “The model they created is one that many have tried to emulate over the years, with the ultimate goal of improving the health of our community. We are confident we will succeed in achieving that goal.”