An interview with Eric Schultz of Fallon Community Health Plan
Implementing successful new health plans requires participation from all parts of the system, notes Eric Schultz, president and CEO of Fallon Community Health Plan.
WBJ: Do you support the state’s new health care reform program?Schultz: Yes. It’s a good bill that takes a significant step toward addressing the needs of the uninsured. If we can get this population in a coordinated health-care program, we’ll be better able to ensure that they get the right care at the right time. When treatment is delayed, both the type of care needed and the costs become much more significant.
WBJ: What is the overall impact of the reforms on the delivery system?
Schultz: There’s no silver bullet. A variety of solutions will be needed. The bill creates three tiers of coverage. People whose income falls below the 100 percent federal poverty guidelines will have their insurance covered in full by MassHealth, the state’s Medicaid program. Those who earn more than 300 percent will be required to have health insurance, either through traditional group health insurance or through an individual mandate. And those in between will have their coverage subsidized on a sliding scale. It’s a very progressive approach. The challenge is: Did we pick the right numbers? But you have to begin somewhere. The bill takes a significant social step forward in requiring that if consumers can afford to pay for health insurance, they have the responsibility to do so. It also dictates that employers have the responsibility to provide insurance to workers – or face a financial penalty. As for FCHP, we are now developing new insurance products for those who fall between 100 and 300 percent of the federal poverty guideline. These plans, which will become public later this summer, should provide solid services – including preventive care – at a much lower cost than is available today.
WBJ: Can you cite some examples of your efforts to curb health care costs?
Schultz: Much of the challenge revolves around care of chronically ill patients. For example, instead of outsourcing disease management programs for people suffering from diabetes or heart disease, our health plan hires local nurses who work directly with these patients on a continuing basis. We contract with hospitals within our communities, and work together on developing clinical programs to improve quality and ultimately reduce costs, and we also offer our Peace of Mind program, so members have access to Boston specialists and hospitals, when they need it.
WBJ: What is your strategy for growing the Fallon Community Health Plan?
Schultz: For almost the first 25 years of our organization’s life, we were the health plan arm of Fallon Clinic, and our coverage area was Central Mass. Over the last three years, however, we’ve gone through a rapid transformation from a group model HMO to a mixed model health-care services company that is both a health insurance plan and a provider. We sell HMOs, PPOs, point of service, and nationwide PPOs. We offer two HMO networks. One is built around a high-performance network of group practices that reach from Central Mass. to Route 128. The other is a more typical health plan model that includes 14,000 physicians and more than 40 hospitals. Employers can offer the choice of either model, with the high-performance option typically carrying an additional 7 to 15 percent employee savings. In terms of geographic reach, we’ve expanded eastward to include the Merrimack Valley and the North Shore. We also are building our network in the southeastern part of the state and taking steps to expand to the New York state line. Membership now stands at about 172,000.
WBJ: What are some popular new benefits with your members?
Schultz: One is an extension of our It Fits plan, which reimburses an individual or family membership in a fitness club. Now, with the growing concern about childhood obesity, we are giving families the option of using that money for their children’s athletic programs at school. Also, at a time when other insurers have been increasing co-pays for office visits, we have introduced a zero-dollar co-pay plan aimed at making preventive health care more accessible. And for seniors, we’ve had a great response to our SilverSneaker Fitness program, which provides full membership to fitness clubs. This benefit not only improves people’s physical health but offers a valuable social outlet as well.
This interview was conducted and edited for length by WBJ Chief Editor Larry Maloney.
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