October 1, 2014

Health Care Trends

Capital Gains

Tallahassee-based Capital Health Plan is a rare bird in the health world: An HMO that has both held down costs and kept its customers happy.

Lilly Rockwell | 9/11/2012

The right ingredients

To be sure, Capital Health has several factors working in its favor, including demography. Leon County and Tallahassee tend to be younger and healthier compared to statewide averages. (Capital Health sells Medicare plans.) State workers make up 45% of its enrollment, providing a stable base.

The insurer’s relatively small size makes communicating with members and physicians easier. The medical staff is able to talk directly to Capital Health administrators about health care decisions, Hogan says. Administrators can’t “hide behind a 1-800 number. You’re part of this town. It’s a small town, and you want to be good because they are your neighbors,” Hogan says.

Capital Health has had the same CEO since its inception 30 years ago, a rarity for any company. And as a non-profit, it isn’t beholden to shareholders.

Capital Health also doesn’t face much competition. Coventry Health Plan and United Healthcare enrolled 22,500 Big Bend residents last year, but both companies were dealt a blow when the state shifted to a one-HMO-per-county rule last year. Capital Health was awarded a $20 million-a-month contract for 2012 to be the sole HMO for state policyholders in the Tallahassee area.

Florida Blue is considered a significant competitor because its preferred provider plan enrolls thousands of state and private industry workers. But Capital Health dominates the market. More than half of Tallahassee residents with health insurance choose Capital Health for health care, and 98% of HMO members in the area chose the company, according to Health Leaders-InterStudy.

Capital Health’s Market Base — Tallahassee

82% — Percentage of Tallahassee residents with health insurance, 304,847 out of a population of 369,758

64% — Of the 196,417 people enrolled in commercial health insurance that don’t self-insure, Capital Health plan has 125,000 enrollees, or 64% market penetration.

98% — Of the 120,828 people enrolled in commercial HMOs, Capital Health Plan has 98% market penetration.

Source: Health Leaders-InterStudy

Insured Floridians

75% — Percentage of Floridians with commercial health insurance plans

49% — Percentage of Floridians with commercial plans enrolled in PPOs

29% — Percentage enrolled in POS (point-of-service, a type of managed care that combines elements of PPOs and HMOs)

19% — Percentage enrolled in HMOs

Tags: Healthcare, Insurance

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