HealthSpring_Story

the needs and challenges facing physicians. We then develop a partnership that provides what our members need – more access to higher-quality preventive care – while giving physicians what they need to deliver that care. Specifically, HealthSpring pays physicians for quality over quantity of care, and we give them extra nurse and technology resources so they can devote more time and attention to their patients. The result: healthier members with lower medical costs. It is a common-sense model, HealthSpring is based in Nashville, Tennessee. We currently own and operate Medicare Advantage plans in Alabama, Florida, Illinois, Mississippi, Tennessee and Texas. We also offer a national stand-alone Medicare prescription drug plan.How we got hereHealthSpring’s history officially began in 2000, when healthcare entrepreneur Herb Fritch saw an opportunity in a struggling Nashville health plan called Health Net, which offered Medicare and some commercial group plans. This was a time of unprecedented downturn in the Medicare industry due to falling government reimbursements, and most plans were pulling out of the business all together. Herb found it was no easytask to raise the capital to purchase a controlling share of Health Net. In the end, he personally carried 15% of the original funding.Herb took ownership of the plan in September 2000, and within a few months, heand a new management team had halted and reversed its losses. In October 2001, the plan’s name was changed to HealthSpring to reflect its new direction and growth. Herb’s strategy was two-pronged: a strong focus on the specific needs of peopleon Medicare, and an innovative approach to organizing and engaging physicians to improve the quality of care for members. He committed to this course at a time when most health plans were leaving the Medicare market and had given up attempting meaningful partnerships with physicians.HealthSpring’s success is based on several key factors that set us apart from other Medicare Advantage plans and enable us to thrive in a complex market.Our concentration on Medicare allows us to better understand the specific needs of Medicare beneficiaries and tailor plans for each of our service areas. Our established expertise in this market is aHealthSpring combines centralized administration with a local market presence to allow us the flexibility to respond to the needs of ourindividual service areas. We believe this operating structure, which includeson-site personnel and local support in each of our markets, gives us a strongadvantage over competitors who have standardized and centralized many or all operations and member services.• Coordinated Care: HealthSpring is committed to a coordinated care approach, with the primary care physician as the key to managing members’ health. Thisteam approach, with PCP as “quarterback” working with specialists, providesopen communication between providers and results in better care for members and improved medical management for HealthSpring. We believe it is our roleto support the member-physician relationship.• Revolutionary Physician Engagement Model: HealthSpring is activelyrealigning the healthcare system to focus on quality preventive care to keepour members healthy. The traditional healthcare system treats patients afterthey are already sick or experiencing complications and forces physicians tofocus on volume rather than quality. Our Partnership for Quality (P4Q) program completely redesigns this model.- Prevention-focused: HealthSpring builds partnerships with physicians andequips them, by paying for quality rather than volume and providing supportresources (such as healthcare IT and an extra in-office nurse), to focus onquality preventive care and better clinical outcomes. HealthSpring enablesphysicians to provide the kind of care they want to deliver but are oftenprevented from providing in our inefficient, volume-driven healthcare system.- Physician-designed: We approach P4Q as a true partnership rather than aprogram dictated to physicians. Physicians helped design this model from theground up and are involved in setting the program’s core standards. Results areevaluated based on physician charts rather than arbitrary health plan data. Thisis a huge differentiation from most other pay-for-performance models.• “HealthSpring views the physician as a partner. They’re honest,straightforward, smart. They take a pragmatic approach to whatmakes the best sense for the patient.” - Michael Bolds, M.D., St.Thomas Health Services• “It’s the most advanced plan I’ve worked with, by far. HealthSpringrewards the doctor’s value to the patient. That’s why we chose to entermedicine in the first place. It’s a breath of fresh air.” - Jim Jirjis, M.D.,Director of Adult Primary Care at Vanderbilt Medical Group• “HealthSpring partners with us in every aspect of how care is delivered.They’re unquestionably the most unique model of healthcare deliveryI’ve worked with in my 29 years of practice.” - Vernon M. Carrigan, M.D.,Premier Medical Group• “They’re the only plan I know that proactively engages doctors on thefront line. They actually modify their policies based on what works bestfor the patient.” - James Jones, M.D., Heritage Medical Associates - Win-win-win: P4Q creates a system where physicians succeed by meetingstandardized quality measures, which allows patients to stay healthier andenjoy a better quality of life and also lowers healthcare costs.- Real results: HealthSpring’s partnership with physicians to focus on qualitycoordinated care has shown tangible results:• Mammograms increased 80%• Diabetic foot exams increased 360%• Flu vaccines increased 246%• Depression screenings increased 71%• Members who were part of this model had fewer hospitalizations andER visits.• Participating physicians made more money, but HealthSpring spentless overall.Looking aheadHealthSpring is a Medicare Advantage plan living the future of healthcare. Medicare currently covers 44 million people, and millions of baby boomers born between 1946 and 1964 will soon begin to qualify. As Medicare’s rolls swell and the country wrestles with improving healthcare efficiency and cost, HealthSpring leads the way with a growing system that aligns the interests of members, physicians, and health planto provide healthcare as it should be. HealthSpring’s industry expertise and unique business model position us for success, and our innovation and commitment to the Medicare market enable us to truly help beneficiaries get more from Medicare and more from life.。