Printer-friendly format

Providers Compensate for Enrollment Loss

Last year, Florida's seven largest commercial health insurers, representing two of three working Floridians, lost nearly 200,000 enrollees as the rising unemployment rate prompted a 2.1 percent drop in total membership over 2007.

The trend of Florida healthcare providers losing paying patients, which continues with the economic downturn in 2009, may force them to reconsider the way they do business.

Of the seven insurers, five lost commercial enrollees, with United Healthcare citing the biggest decline at 15.9 percent. Aetna, Cigna, Humana and Vista Healthplan also lost commercial members last year. Only Blue Cross Blue Shield of Florida (BCBSF) and AvMed Health Plans increased commercial enrollment.

Blue Cross's Smart Plan

In addition to being one of two statewide providers participating in Cover

Florida – the low-cost, limited-benefit health plan for the uninsured approved by state lawmakers – introducing low-cost plans with limited benefits such as preventive care without hospital services, and capitalizing on growth in health savings accounts and high-deductible products, BCBSF recently made several moves that attributed to its 4.1 percent increase to 4.27 million members in 2008.

Noting early on that individual coverage represented the industry's highest growth area, even with those covered by group insurance that wanted more options, the Jacksonville-based insurer introduced a new concept in 2007 when it opened a retail store in Jacksonville and later Pembroke Pines.

"The Jacksonville store has done well for us, and more importantly, we've found it helps us retain customers," said Michael Guyette, senior vice president of sales and account management for BCBSF.

Florida Blue was a new concept and part of a broader stroke to personalize health insurance and allow the consumer to embrace new services, such as a patient cost calculator and quarterly personalized health reports.

In the retail store setting, Blue Cross agents could provide education and information on health, dental and life insurance to consumers in a low-pressure manner. Existing customers could receive counseling about their policies. Now pharmacies, supermarkets and big-box retailers have entered the retail landscape. Buoyed by their retail success, BCBSF plans to open four new Florida Blue stores this year in Orlando, Miami and Tampa.

Also in 2008, BCBSF acquired Florida Health Care Plan Inc. from Halifax Hospital Medical Center in Daytona Beach, serving Volusia and Flagler counties. Florida Health, a 53,000-member healthcare plan, will serve as a community-based HMO subsidiary of Blue Cross and continue to serve small and large employer groups, Medicare Advantage Part D Plan and the Cover Florida Plan. Some 300 physicians, including 60 employed doctors, a dozen healthcare facilities and eight pharmacies in the two-county area, participate in the plan.

This summer, BCBSF will unveil a new plan, pending county government approval, for the nearly 600,000 uninsured residents of Miami-Dade County, offering benefits in a small network of community providers to reduce costs.

AvMed's Advantage

By focusing on small- to mid-size employers, which it had traditionally overlooked as a marketing priority, AvMed increased its enrollment 5.2 percent to 234,673 commercial customers in 2008.

"In the marketplace looking for health insurance coverage, premium levels and price have become more important factors, and it's more pronounced in small groups," said Jim Repp, vice president of sales for AvMed, explaining that overall, companies are shifting more costs to employees while reducing benefits to decrease premiums. Many smaller companies are canceling insurance coverage altogether. "It becomes, 'How many employees do I have to eliminate to keep the coverage?' and that's a difficult decision."

To capitalize on that trend, AvMed is heavily promoting its new individual health plans in 2009.

Humana's Humanity

Even though its commercial membership dropped 2.4 percent to 325,000 last year, Humana increased enrollment in its individual plans. That boost is attributed to layoffs, an increase in the part-time workforce, and smaller companies dropping group plans while compensating for the loss by providing employees cash payments. "Anytime you have turmoil in the market, there's also opportunity," said Tim Love, South Florida commercial market president for Humana.

Health Insurance Reform

Insurers are paying keen attention to health insurance reform discussions. President Obama made headlines when he visited Ft. Myers, where Medicaid applications have increased some 24 percent. Florida Medical Association spokesperson Lynne Takacs calls Ft. Myers "ground zero for the Medicaid challenges in Florida."

"They're having reimbursement issues and foreclosures as people struggle to afford healthcare there," she said.

Linda Quick, president of the South Florida Hospital and Healthcare Association, said the influx of uninsured patients has led to more uncompensated care at local hospitals and a bloated budget for Florida Medicaid. As a result, hospitals have reduced hiring clinical employees and laid off non-clinical employees while also curbing capital spending. The higher uninsured rate should strengthen President Obama's call for action.

"People are more likely to be stronger advocates for reform," she said, "when it's all of a sudden their healthcare plan that's lost."


SIDEBAR:

---