Health Care Trends
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.
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.