New Emergency Clinic Affiliated With Health Insurer

By Scott Powers, Orlando Sentinel.

By the end of the year, a new emergency-care center in Winter Park will open, offering treatment for broken bones, heart palpitations and even more serious medical issues such as strokes.

The twist: The health center will be directly affiliated with a health-insurance company.

GuideWell Emergency Doctors and Blue Cross Blue Shield of Florida will be owned by the same company, GuideWell Health, that has begun purchasing or opening doctors’ practices in Largo, Tallahassee and now Winter Park.

Expected to open in the fall, the 7,500-square-foot emergency facility will have 15 to 20 examination rooms that could handle major medical issues such as heart attacks, strokes and internal injuries and less-critical problems such as cuts needing stitches. It will be open to people with any type of insurance.

“Our main goal is to provide people access to care as they need it in a higher-quality, better-cost environment,” said GuideWell Health President Dr. Jonathan Gavras. “Everyone will be treated the same. It will be based on what your benefit plan is, not on the [insurance] payer.”

Some industry observers worry that insurance companies might discourage affiliated clinics from performing tests patients should have in order to cut unnecessary procedures that run up insurance bills.

“When an insurance company gets involved in primary care or emergency care, what they are trying to do is manage that cost,” said President Bruce Rueben, president of the Florida Hospital Association. “What you want is appropriate transparency and accountability for all. … If you know what kind of work they’re going to do, and how it’s working out, you don’t have to fear that the incentive for controlling costs are not in the best interests of the patients.”

Gavras said the doctors still will make the call on what is best for patients.

“The idea is not to tell them how to manage the patients,” he said.

The trend of insurance companies owning health-care providers — called a “payer-provider” system — has come and gone before, in the 1990s.

Now analysts say it is arriving in a new way: aiming small. Before, insurance companies focused on buying hospitals but eventually found too many patients and doctors uncomfortable with insurance-owned medical centers, said Ted Schwab, partner at the Health and Life Sciences practice of Oliver Wyman, an international management-consulting company.

“‘Payer-provider 2.0′ is a really good way to put it,” he said. “Both times, it’s been spurred from activity from the federal government. Back in the ’90s, it was health-care reform 1.0 from the Clinton administration. Now it’s the Affordable Care Act.”

Obamacare is restructuring health-care business in a number of other ways. Some hospitals, including Orlando Health, Florida Hospital and Nemours, are buying doctors’ practices. Some hospitals, such as Florida Hospital, are starting their own insurance companies to offer to their hospital patients.

GuideWell expects to expand its doctor network across the state, Gavras said. And though other insurance companies have not announced specific plans yet, observers expect they will be looking as well.

“As best as I can determine, some of this [payer-provider activity] is driven by the hospitals being very aggressive in trying to acquire physician practices,” said Jeff Scott, general counsel for the Florida Medical Association. “So for whatever reason, physicians not currently affiliated with a hospital, they’re looking for alternatives. For some of them, an affiliation with an insurance company may be attractive.”

May 7, 2014

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