Parrish Medical Center Board votes to end contract with Health First Health Plans

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Citing hospital’s mission, patients’ interests and need for confidence in insurance carriers, PMC Board votes to end contract with Health First Health Plans

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Saying that Parrish Medical Center’s (PMC) mission of healing experiences for everyone all the time® includes how patients are treated by insurance companies and the trust PMC must have that organizations will keep their agreements, the PMC Board of Directors voted Monday night to end the hospital’s relationships with Health First Health Plans (HFHP).

    Existing PMC – HFHP agreements will end on December 7, 2014. This includes HFHP’s Medicare and commercial products.    

    Parrish Medical Center officials cite Health First Health Plans’ referral restrictions on health care services; communication restrictions with HFHP members; no program that recognizes PMC’s record of superior clinical quality, safety and low-cost; and Health First’s breaches of previous agreements as reasons for ending the hospital’s contract with HFHP.

    With the upcoming open enrollment period for Medicare and other insurance programs approaching, area residents wishing to use PMC should select insurance carriers that have a contractual relationship with the medical center, hospital officials say.

    “This decision was difficult, but necessary,” said Tim Skeldon, Parrish Medical Center’s executive vice president of corporate finance. “We wanted to make the community aware of this change before the upcoming open enrollment period for Medicare plans, which runs from October 15th to December 7th.”

    Some 5,000 north Brevard residents are affected, Skeldon estimates. Exact figures are not available because unlike other insurance carriers, HFHP restricts direct contact with its customers.

     “During the open enrollment period, employers and residents within our service area have the ability to choose an insurance carrier affiliated with Parrish Medical Center so they can continue to use a hospital that is nationally recognized for clinical quality, safety, low-cost and excellent patient satisfaction rankings.”

    According to PMC officials, the issues motivating the decision are:

  •     Patients have difficulty in getting a referral outside of Health First’s network and the network of providers is smaller than most other insurance carriers. For example, residents of north Brevard who need home health care or physical therapy are generally referred to Health First practitioners, creating scheduling and transportation difficulties for north Brevard residents. Other insurance carriers, for the convenience of patients, typically refer to associated services anywhere in the community.
  •     Health First Health Plans restricts PMC from having direct communication with patients who are HFHP customers. This restriction interferes with the hospital’s ability to communicate with patients to educate and support them in the best management of their health. This restrictive practice is unique to HFHP and not a practice that is shared by other insurance carriers.
  •     Health First Health Plans has been unwilling to recognize PMC’s quality, safety and low-cost record in how it reimburses for patient services. In fact, The Centers for Medicare and Medicaid Services (CMS) recognizes hospital quality and safety records, reimbursing PMC and others who achieve CMS’s standards for high quality, safety, patient experiences, low cost and low readmission rates.

Just one such example, said Chris McAlpine, PMC chief transformation officer, is Parrish Medical Center’s record in lowering the rate of patients’ readmissions to the hospital.

    “Under health care reform the government is looking at readmission rates because they are a quality of care indicator and because the more times patients have to be readmitted for the same problem, the greater the costs,” McAlpine said.

    “Our low readmission rates mean that Parrish Medical Center is the only Brevard County hospital that is not going to receive a readmission rate-related reduction in government reimbursement,” he said. “Other insurance carriers take Parrish Medical Center’s record in this and other care quality and cost-reduction successes into consideration when determining how they will pay PMC. Health First Health Plans does not.”

    Skeldon said the open enrollment period for Health First Health Plans Medicare Members is from October 15th to December 7th. During this period Medicare patients have the opportunity to decide whether to switch Medicare insurance carriers. The enrollment period for commercial health insurances may vary. If you are a HFHP member with a commercial insurance plan you should check with your employer for enrollment dates.

    “There is great competition between insurance companies for these members,” he said. “Health First Health Plans members have the opportunity, during the open enrollment period, to decide if they want to change to an insurance carrier that is working with Parrish Medical Center or switch back to traditional Medicare”

    After December 7, 2014, Parrish Medical Center will be considered an out-of-network provider with respect to HFHP. However, by law, HFHP members are still able to use PMC emergency services.

    “We want to give people time to consider what course of action is right for them,” said Skeldon. “The final consideration for us had to be the overall well-being of our patients and their families.”

About Parrish Medical Center:
Parrish Medical Center, located at 951 N. Washington Ave., Titusville, Florida, is an award-winning, not-for-profit acute care public medical center with an array of outpatient health service centers serving Brevard County for more than 50 years. PMC ranks as Central Florida’s No. 1 hospital, America’s No. 5 independent public hospital, and in the top six percent of all U.S. hospitals. These rankings are based on data compiled by the Centers for Medicare and Medicaid Services (CMS) on clinical care, the quality of the patient experience, and cost. In May 2014, PMC earned its fifth straight ‘A’ Patient Safety Score from the Leap Frog Group, an employer-based coalition advocating improved transparency, quality and safety in America’s hospitals. Visit http://www.parrishmed.com.

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Natalie Sellers, MS, APR
@ParrishMed
since: 05/2009
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