HealthSpring CEO
The HealthSpring Story
The Medicare market might not be the place you would expect to find real innovation reshaping the way healthcare is delivered. Let us introduce you to HealthSpring, a company born from one man’s entrepreneurial vision for a better way to meet the healthcare needs of Medicare beneficiaries. That vision has grown into a revolutionary approach to healthcare that is helping our members live healthier lives. It is also pointing the way to a better American healthcare system.
Where we are today
HealthSpring is one of the largest Medicare Advantage coordinated care plans in the United States. Our concentration on this market has allowed us to develop a unique approach to healthcare coverage for Medicare beneficiaries.
We begin with a deep understanding of the needs of Medicare beneficiaries and 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, but an uncommon practice.
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 here
HealthSpring’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 easy task 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, he and 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 people on 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.
Using this model as a foundation, HealthSpring grew at a rapid pace:
- November 2000 – Started an Independent Physician Association management company in Houston, Texas, and helped form the Renaissance Physician Organization, which brought together more than 1,000 physicians and hospitals as an effective network of care providers for Medicare health plans.
- November 2002 – Purchased a struggling Birmingham health plan.
- Also November 2002 – Began a Medicare plan in Houston, Texas.
- 2004 – Began a Medicare plan in Chicago.
- Also 2004 – Added service areas in several Mississippi counties.
- 2005 – Continued expansion into new counties in Alabama, Tennessee and Texas.
- Also 2005 – Began offering a stand-alone Medicare prescription drug plan.
- February 2006 – Completed an initial public offering , with stock traded on the NYSE under the ticker symbol 'HS.'
- October 2007 – Purchased Leon Medical Centers Health Plans in Miami, Florida.
- 2008 – Continued expansion into North Texas and the Florida Panhandle.
- March 2009 – Reached 175,000 Medicare Advantage members and nearly 287,000 Part D-only members.
Why we succeed
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.
- Focus on Medicare Advantage: 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 a distinct competitive advantage.
- Local Roots: HealthSpring combines centralized administration with a local market presence to allow us the flexibility to respond to the needs of our individual service areas. We believe this operating structure, which includes on-site personnel and local support in each of our markets, gives us a strong advantage 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. This team approach, with PCP as “quarterback” working with specialists, provides open communication between providers and results in better care for members and improved medical management for HealthSpring. We believe it is our role to support the member-physician relationship.
- Revolutionary Physician Engagement Model: HealthSpring is actively realigning the healthcare system to focus on quality preventive care to keep our members healthy. The traditional healthcare system treats patients after they are already sick or experiencing complications and forces physicians to focus on volume rather than quality. Our Partnership for Quality (P4Q) program completely redesigns this model.
- Prevention-focused: HealthSpring builds partnerships with physicians and equips them, by paying for quality rather than volume and providing support resources (such as healthcare IT and an extra in-office nurse), to focus on quality preventive care and better clinical outcomes. HealthSpring enables physicians to provide the kind of care they want to deliver but are often prevented from providing in our inefficient, volume-driven healthcare system.
- Physician-designed: We approach P4Q as a true partnership rather than a program dictated to physicians. Physicians helped design this model from the ground up and are involved in setting goals for their own practices. Results are evaluated based on physician charts rather than arbitrary health plan data. This is 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 what makes the best sense for the patient.” - Michael Bolds, M.D., St. Thomas Health Services Center for Sleep
- “It’s the most advanced plan I’ve worked with, by far. HealthSpring rewards the doctor’s value to the patient. That’s why we chose to enter medicine 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 delivery I’ve worked with in my 29 years of practice.” - Vernon M. Carrigan, M.D., Outpatient Medical Director with Clarksville Medical Network
- “They’re the only plan I know that proactively engages doctors on the front line. They actually modify their policies based on what works best for the patient.” - James Jones, M.D., primary care physician with Heritage Medical Network
- Win-win-win: P4Q creates a system where physicians succeed by meeting standardized quality measures, which allows patients to stay healthier and enjoy a better quality of life and also lowers healthcare costs.
- Real results: HealthSpring’s partnership with physicians to focus on quality coordinated 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 and ER visits.
- Participating physicians made more money, but HealthSpring spent less overall.
- Prevention-focused: HealthSpring builds partnerships with physicians and equips them, by paying for quality rather than volume and providing support resources (such as healthcare IT and an extra in-office nurse), to focus on quality preventive care and better clinical outcomes. HealthSpring enables physicians to provide the kind of care they want to deliver but are often prevented from providing in our inefficient, volume-driven healthcare system.
Looking ahead
HealthSpring 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 plan to 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.