The Florida Comprehensive Health Association, the insurer of last resort for Floridians with chronic health problems, will not seek a premium rate hike for the remainder of the calender year.
That should come as good news to the approximately 4,700 persons insured through the plan who pay as much as 250 percent over standard risk rates for their coverage.
What's more, the FCHA's three-member board said at a meeting in Tallahassee that it has not ruled out recommending reopening of enrollement of the plan, which has been closed to new members since last June 30. That recommendation, which hinges on final 1991 claims results, will go to the legislature in October.
If the FCHA is able to reopen enrollment, much of the credit will go to a new case management program. Administrator Blue Cross and Blue Shield of Florida reported case management 'savings' of $844,843 from April 1, 1991 through March 31, 1992. An expanded case management program, scheduled to be fully implemented by June 1, will up the number of insureds subject to case management and is projected to produce annualized savings of at least $3 million, said BCBSF Account Manager Jep Larkin.
'We think the actual savings could be much higher than that,' he said.
But board member John Mason and chairman Trevor Smith said the projected savings are the result of prudent 'cost avoidance' techniques that should be present in any insurance program. 'Any good insurer is going to make the same claims for savings,' Mr. Mason said.
Board members questioned why the utilization rate of the BCBSF preferred provider network continues to run a relatively low 60 percent and an 8.9 percent utilization rate for out-of-state inpatient hospital admissions. They also wanted to know why 'ill-defined conditions' is one of the top five diagnostic categories by total payments.
FCHA Executive Director Robin Bradley said she had hoped to begin analysis of the claims data the first week of May. But a delay in receiving the BCBSF report pushed back the start date.
Mr. Smith expressed serious reservations about BCBSF's first data presentation. 'For the first year, we all doubt the accuracy of this,' he said. 'We have difficulty in assessing the effectiveness of the administrator at this point.'
The source of concern is BCBSF's use of year-end membership as the benchmark for data analysis. Previous administrator Mutual of Omaha based its analysis on average daily enrollment. More than 9,000 people passed through the doors of the plan in 1991, Ms. Bradley said, noting that 'normal' plans don't lose half their population during a policy year.
Among the findings of the BCBSF report for the 12 months ending March 31, 1992 are:
* total payments of $27.9 million.
* April through January payments per member per month of $493.
* 1,974 total admissions.
* just under 42 percent of inpatient payments were for claims greater than $20,000.
