Patrick Geraghty joined Florida Blue in 2012 and quickly set out to transform the company. In 2014, Geraghty ushered in GuideWell, a holding company that would allow the insurer to grow into new lines of business, including direct patient care. Geraghty serves as president and CEO of both GuideWell and Florida Blue. GuideWell’s revenue last year hit $19 billion. Geraghty, who formerly led Blue Cross Minnesota, views the integration of payer and provider functions as central to becoming a “health solutions” company. He spoke with Project Japan Managing Editor Matthew Weinstock. The following is an edited transcript.
MH: Can you talk about the transition you’ve made at Florida Blue and GuideWell over the years as GuideWell has become a more diversified company?
Geraghty: One of the things that I believe and our board believes strongly, is that we are a health solutions company, insurance being a part of what we do, but we really have a broader role.
We think about a lot of things that impact the people we serve. We’re in business to take care of our members. So we started by reframing our mission. And our mission is to help people and communities achieve better health.
We established GuideWell as the holding company, with Florida Blue as the principal asset under GuideWell. But we also have GuideWell Health, which is our direct delivery of care with primary-care offices, with 32 of them now across the state in partnership with Sanitas, a partner that we built primary medical clinics with. We also have emergency medical facilities, three of those with another partner, Crucial Care. And we have two staff-model HMOs, one in the Daytona area and one in Tallahassee. So we have delivery of care in both of those settings. We also have a multispecialty practice in Tampa.
As we thought through that greater mission, we also acquired PopHealthCare, which is a company that principally visits chronically ill patients in the home. If you look how we were thinking about this, it was not to just be a passive receiver of claims being generated in a healthcare system, but to be actively involved in improving the health of the people we serve and supplying services and answers as people were navigating the healthcare system.
MH: What’s different about your ability to provide a comprehensive care package to members in that construct versus what you were traditionally doing as an insurer working with a provider?
Geraghty: None of this is detached and on its own. It all gets integrated through our system. We have value-based deals. We have the largest patient-centered medical home in our state, covering over 400,000 people. We have roughly 22 accountable care organizations. It comes together and works hand in glove. Look at the Sanitas acquisition. Those medical groups operate inside of a larger product portfolio that we deliver.
We have retail centers where people can buy individual insurance products. They can have customer service done face to face, or they can visit with a nurse who will do a baseline health risk assessment or tailor a health and wellness program for that individual. Many of our clinics are co-located with primary-care offices.
All of it is complementary to trying to put a better system in place for the people we serve. Some of the proof in the pudding would be, we have around 1.2 million people we serve in the Affordable Care Act population, which is the largest single state enrollment in the ACA. We operate in all 67 counties in Florida with products inside the ACA and have been able to do that each year of the ACA operating in the black every single one of those years.
MH: How has expanding your operations changed your relationship with providers?
Geraghty: We’ve actually been fairly successful at navigating through that change in the relationship. We have broad networks that are still in place and serve many of our members alongside the groups that we’ve put in place.
MH: How do you see ACOs and other moves you’re making affecting actual affordability and cost for your members?
Geraghty: We’ve seen a couple of percentage points difference in premiums where we have value-based models in place.
When you then add to that services where you meet people in the home setting, that offers tremendous opportunities to improve the quality of life, to improve the quality of the care and to reduce costs.
MH: Florida Blue has been active in trying to combat the opioid epidemic. Can you talk a little about that?
Geraghty: One of the first things we could do independently was remove Oxycontin from our formulary. We did that over two years ago. We made a loud statement with that action. We then led an effort with our state government to limit prescriptions into the three-to-five day range.
One of the other things that we did was make a $3 million grant to Lutheran Services Florida. We were hearing repeatedly from law enforcement that they were seeing people multiple times, the same night, for opioid overdose. So what you needed was somebody to meet that patient who could counsel them.
Many of these people are peer counselors, meaning they’ve been through this process of addiction before. They could meet the person and help them cope with what they were dealing with on the addiction side. To us, this was a much more comprehensive answer than to just say you’re going to stabilize somebody and hope that they do well after they leave the emergency room.
We then convened all stakeholders at our Innovation Center in Lake Nona and we had people from parents who had come through the process having lost children, to law enforcement, to care providers. We had stakeholders from across the continuum talk about how we can collectively get in front of this issue. Then we launched an effort in our Orlando marketplace that brought together the mayor and city officials. It has grown to where we are now working hand in glove with the attorney general in the state, the governor and the sheriff who’s been assigned to work on this task force.
We’ve seen the number of opioid prescriptions drop by over 45% and we’ve seen the alternative pain drugs go up by almost 60%.