By James
Gutman - January 8, 2015
It doesn’t take a genius to know why
Florida has attracted so many Medicare Advantage (MA) plan sponsors. The state,
of course, is crawling — so to speak — with seniors, and its high prevailing
Medicare fee-for-service payment rates have meant in the past high pay for MA
plans. But Florida also apparently has had more recent MA plan closings than
any other state because of both insolvencies and regulatory issues, including
three since the beginning of 2013, and another MA insurer has been fighting a
state suspension order entered last October. So success in Florida’s MA market
has not been easy to come by — except for Miguel “Mike” Fernandez.
This time it took Fernandez and his
seasoned top bilingual operatives in MBF Healthcare Partners, L.P. only four
years to start a Florida MA and managed Medicaid insurer, Simply Healthcare
Holdings, Inc., from scratch and build it so successfully that Anthem, Inc.
late last month agreed to buy it for a price that reportedly is near $1
billion. It’s the third time he stands to make a killing with Florida health
plans, and that’s aside from profitable sales of dental and pharmaceutical
units. The other health plan successes include on the MA side CarePlus, bought
for $28 million and sold for $450 million, and on the Medicaid side Physicians
Healthcare Plans, started with $3 million and sold for $185 million in 2002 to
Amerigroup Corp., which perhaps coincidentally now is a unit of Anthem.
What is Fernandez’s secret? It
seemingly starts with knowing his market, which is largely Hispanics in
Florida. That led to his building medical clinics for CarePlus Health Plans,
based on the knowledge that his major clientele would be drawn to them not just
for needed health services but also as a social center. It also led to his
committing to Medicaid managed care even when it got off to a rocky start in
Florida in 2006 and subsequent years, because he saw its growth there as
inevitable. Shrewd provider contracting has been a linchpin of Fernandez
insurers in Florida. And so has been knowing when to sell, achieving exito
(Spanish for success) by planning a well-timed exit.
How do you think Anthem will fare with
the Simply Healthcare business? Will it run into the same kinds of problems
Humana had with CarePlus when it sought to cut back the clinic aspects without
apparently recognizing their social role? Or has Anthem showed it learned that
lesson by retaining Simply’s top plan management, led by CEO Lourdes Rivas? And
what do you think Fernandez will do next aside from enjoy the fruits of his
latest triumph?
No comments:
Post a Comment