How Does The Villages Health System Work?
 

As a retired banker, I'm trying to figure out how the new Villages Health System works as a business entity.

Articles I've read say that a single doctor with a receptionist, nurse and modest office space must see 8 Medicare patients per hour in order to make a reasonable amount after paying all his expenses. (Assuming his patient roster is heavily Medicare-insured, as is the case in The Villages.)

The Villages Health System says that patients can enjoy extended visits with their primary care doctor. There has been a suggestion that doctors in the system will be paid a salary and that VHS will not be a fee-for-service model. And we can clearly see that the staffing and luxury of the offices are well above the norm, resulting in an above average cost structure.

So as a business, how does The Villages Health System make a profit? Sooner or later that has to happen. Medicine is a business. I just can't figure out how it will work. Does anyone have an explanation?

I'm guessing it is a capitatated system as think I read they are partnering with United Healthcare. Under capitation a managed care company like united pays the health system running a clinic a per member/per month fee. This fee is paid whether the member has a medical visit that month or not. It can be a very lucuritive payment plan if you keep your patients as healthy as possible so they don't need to come to the clinic for a visit.

[COLOR="Green"]It can be a very lucuritive payment plan if you keep your patients as healthy as possible so they don't need to come to the clinic for a visit.[/COLOR]

And this is the goal so should be a win, win for everyone as long as they have GOOD doctors.

My understanding of how the medicare advantage plane work is that the plan has a contract with medicare to provide care to me. Medicare pays the plan (Preferred Care Partners in my case) an annual sum to provide services to me. I don't know what that amount is but I have heard that is is in excess of $12,000 a year. So the provider is making a lot of money as all I have had during the past few years is six month checkups and a few steroid injections.

So, I guess there might be an incentive for the provider to provide minimum services?

Anyone else know how it works?

This is how you will get "Marcus Welby" healthcare:

Coming Soon To America: A Two-Tiered, Canadian-Style Health Care System - Forbes

Having previously worked for a large health insurer / health care provider, these kind of systems worked fine when they were first developed. The reason they were initially successful was their large popularity with young families looking for well child care with little out of pocket expenses. They were known as HMO's or in the sales department as, healthy members only (HMO).

Some HMO models included specialist which were on retainer or contracted for services. Referrals were made to the specialists associated with the health care plan. This model worked well until someone with a serious illness wanted to seek care from one of the top docs and discovered they did not have a choice. The response was you can see whoever you want to see, but we are not going to be financially responsible unless you see one of our specialists who we think is capable of treating your condition.

As people age they need more care and want to have some say in the medical care they receive. Staying healthy is certainly a key to needing less medical care, but age can not be ingnored.

The health model being described in this discussion reminds me of a Kaiser. Doctors are recuited to work for a salary and costs are paid for by Medicare through a Medicare Advantage Plan. A Medicare Advantage Plan is insured by a health insurer who agrees to cover the same basic medical services Medicare pays for. This model can work very well for many Medicare Eligible people, because it gives them access to medical care with less out of pocket expenses.

The initial concern of HMO's is still hiding in the back ground. The plans hire what they determine to be the best doctors and will refer you to specialists who they deem are capable of caring for your needs. I can't stop asking myself, why don't top docs join HMO's?

JMHO

Top doctors don't join HMOS because the HMO manages the patient's care, rather then the doctor and patient managing the care. Referrals, tests, surgeries, etc.all have to be approved by doctors and nurses who work for the HMO. The care is not quality care. Although patients have an 'assigned' PCP, they see whoever is available when they call for an appointment. There is a huge HMO in WA state that has been in business for over 30 years. Although the premiums are less than other non-HMO plans, the consistency and quality of care is lacking. I have been to the Villages Colont Care Center twice now, and I don't see it operating like an HMO. Just my opinion, of course.

More Questions Than Answers
 

Your reply raises some important questions.

• My understanding is that the Developer owns and is funding VHC. He is hiring 64 primary care doctors to staff the eight offices. I'm told you will have a choice of doctors, but only among the eight at "your" office. You can only be a VHC patient at the office to which you're assigned (based on the village you live in). What if you don't like any of the doctors or nurse practitioners at the office to which you are assigned? What if they leave?

• What secondary insurance will you carry? Your choice seems to be the single HMO-type plan offered by VHC and it's United Healthcare partner. What will it cost? How does it cover claims outside the VHC system of primary and specialist doctors? What if you are traveling, what coverage? What if you have a longstanding relationship with a specialist who is not part of the VHC system?

• Will VHC patients be required to use The Villages Regional Hospital? Without starting another discussion here, TVRH has been roundly criticized both here as well as among all the local doctors I've asked about how TVRH stacks up. Without exception every medical professional I asked (five doctors and several nurses) responded by saying, "...don't go there. It's beautiful, but it's a bad hospital. Go to Monroe or Ocala General." But there must be a reason why TVRH is substantially expanding their number of beds. Questions here, certainly.

I haven't thought very much about the questions I would have regarding TVHC system. These are a few which immediately come to mind. It sounds like an attractive idea, but would we be giving up all flexibility regarding our health care choices? Kaiser was mentioned here. As with most HMOs, with Kaiser you can't see a specialist unless your primary care doctor refers you. And then, you're referred to "their" specialist, not one you might choose.

ObamaCare has been intensely criticized as government taking over too many decisions regarding our health care. What's been said here so far suggests that the partnership of United Healthcare, TVRH and the developer (who owns VHC) appears equally controlling. As a retired banker I'm a little uncomfortable, maybe more than just a little, having my healthcare choices dictated by profit-driven entities.

Am I missing something? Is anyone here a patient of Villages Health Care. I'd love to have some if these questions answered first-hand. I'd really love to be told I'm reaching some incorrect preliminary conclusions.

VK, some of your questions can be answered here: The Villages Health The FAQ and Accepted Insurance pages should be helpful.

At the recent Meet the Developer meeting held by the VHA, Mark Morse stated that you may choose your location and choose your doctor.

Regarding insurance, it appears to me that you may have either 1) Medicare plus many Medicare Supplement plans; or 2) one of these Medicare Advantage plans - Preferred Care Partners or United Healthcare.

I read or heard that initially you would be limited to docs in the center servicing your area....until enough centers are built...then you can choose a doc from a different center. They just didn't want 100,000 villagers all trying to get into colony. With their ambitious building plan, this "choose a location" dilemma should be a moot point in a year.

Not necessarily. It's also up to the patient. I know many people who have taken themselves off their prescribed medications because of some fragment of info taken out of context that Dr. Oz or somebody else on television talked about. "Good" doctors can't make people take their medicine and alter their unhealthy and risky behaviors.

Thanks for the link, champion6. It certainly answers many questions asked here plus a lot of others. I encourage others to go to the link to get their answers.

My family is Canadian and have generally been highly successful financially. There isn’t a one of them who cannot afford to buy into what is referred to in the article as a second tier. Yet none of them has ever felt the need to do so. They’ve been newlyweds, they had children, they raised their families (or are raising their families), and those who have done so are now older and retired. So at every stage of life they’ve felt that the basic care provided by the government through their taxes has been all that they’ve needed.

I would have to say, though, that it appears that Canadians have a much better understanding and acceptance of the principle of TRIAGE and are not inclined to balk and complain when someone else’s stroke “trumps” their sprained ankle, even if they got to the emergency room first. Granted they’ve had many years of universal health care to have learned the workings of this principle, but at least EVERYONE has access to health care!

I have gone to Colony Health with my Blue Cross insurance and it is honored. I am not yet Medicare eligible. The completely screwed up the billing, but that's another issue.

I went to colony with a bluecross blue shield Medicare advantage PPO. They told me they do not take that plan. I asked why, it was kind of hinted that my plan does not pay enough. My wife has the regular bluecross blue shield plan and she is covered. As I understand, my plan is a top notch plan. So here I sit in the villages and read about the great healthcare system that is being put into place, for some.

More Questions Than Answers
 

I did read the information from the provided link and I was still left with questions. It seems to read--but I could be wrong-- that if you qualify for Medicare, you must chose one of the Medicare Advantage plans approved and in partnership with VH. If you have not yet qualified for Medicare, VH will accept insurance from the list provided on their website.

To try to get more information I contacted VH and asked about what insurance would be accepted by them, specifically for my wife and I. Can we maintain Medicare A and B plus a supplement, or do we have to join a Medicare Advantage plan?

I also asked about our ability to choose, maintain a relationship with and visit specialists without the approval and referral of a VH doctor. And I also asked if hospitalization at The Villages Regional Hospital is the sole choice for VH patient/members.

Those were my starting questions, but I know I have many more. When I get answers, I'll share them here.

To all posters on this thread......terrific thread and sharing of information.

Thanks to all.

Here's something you might find interesting: It was said there will be 64 doctors and each doctor will be limited to 1,250 patients. That means The Villages Health will be able to handle 80,000 patients.

When this all started it was said that the TV Health Clinics would not take business away from other doctors who are already doing business here. However, with a total population of about 100,000, what do they plan on leaving for the other doctors? 100,000 - 80,000 = 20,000 patients to keep all the other doctors going.

Is that fair? First the developer sells or leases property to them and then sets up clinics to take their business away?

I have a Medicare advantage care plan that was provided by my employer. I do not have to pay for it . It was a benefit I received. It sounds like you must buy a plan from the partners that the villages health care has listed.

Kahuna,

At an informational meeting at Colony we attended we were told that original Medicare plus AARP United Healthcare supplement was "golden." I don't know about other Medigap policies.

We were also told that we could go to the hospital of our choice, i.e., Munroe, Ocala Regional, etc.

If a physician has earned the respect and trust of his/her patient I doubt they will leave that physician to join TV Health Plan. Competition is a good thing - even in medicine.

Preferred Care Parners is owned by United Healthcare.

[QUOTE=gomoho;681097]If a physician has earned the respect and trust of his/her patient I doubt they will leave that physician to join

Oh yes! competition is so good! we have run across a set way of thinking here in the medical field that is NOT proactive, progressive, patient-centered. we are excited for new developments here in TV that will stop this "I know it all, so therefore follow my rules" mentality.

Putting Money Behind An Idea
 

I don't know whoever said that the creation of Villages Health wouldn't take patients away from existing doctors. What I've discovered is exactly the opposite--the plan is to drive many local doctors out of business here.

In a conversation with one of my doctors, a specialist who was involved with the consulting study commissioned and paid for by the developer regarding healthcare in The Villages and the quality of care in the hospital, she described some of the findings. One of the consultant's conclusions was that healthcare here was limited by the quality of the doctors practicing in this market. The explanation was simple to understand. Many of the doctors practicing here came even before The Villages Regional Hospital was built. Many opened practices with no admitting privileges to any of the hospitals in the area. Many we're educated in non-certified foreign medical schools, were not board-certified and came here knowing they would have to "make a go of it" with patent rosters which were heavily Medicare-insured. That formula has resulted in questionable quality healthcare on average, and a hospital that despite top notch facilities, is not highly regarded. The core problem according to the consultants is the competence of the doctors practicing here.

Those conclusions along with the developer's desire to dramatically improve healthcare in The Villages have lead to several results--the addition of the Moffitt Cancer Center to TVRH, the partnership with the USF medical school, and now the creation of Villages Health.

The doctors who will be hired by Villages Health will all be educated in U.S. medical schools, will all be board certified, and will all agree to work for a salary, which was reported to be quite generous in an effort to attract high-quality doctors. The business model is the same as the Mayo Clinic, Cleveland Clinic, Kaiser Permanente, etc.

When I questioned whether the lower quality doctors would have their hospital admitting privileges withdrawn, the answer was no. The feeling is that sixty-four new, competent physicians, practicing in a patient-responsive way, will drive the lower quality doctors out of business in a relatively short time.

I suppose some can call this unfair, but the practice of medicine in the end is a business. The clientele and patients will migrate to higher quality, more effective, lower cost healthcare. That's the free market economy that most of us embrace.

I haven't made up my mind whether Villages Health is for me. That's why I sought some answers to questions. But I do know that the the developer should be complemented for the actions he's taking, putting lots of money behind his desire to improve healthcare here and not waiting for many of the provisions of ObamaCare to kick in.

Answers To Questions
 

I did pose a few questions to Villages Health via their website.

I got the following prompt reply. I intend to follow up. Some of you might too. Here's the response...

"All of the answers to your questions and more can be learned at the information sessions, which are held at the Colony Care Center. You will learn about The Villages Health and receive an enrollment packet to prepare to take the next step in the process, if you choose. The information sessions are held on Tuesdays at 10 AM and 12 Noon, Wednesdays at 2 PM and Thursdays at 1 PM and 3 PM. I will be happy to schedule you for one of the sessions that meets your schedule.

Adrienne Jaworski
<Adrienne.Jaworski@thevillageshealth.com>

"

Are these sessions ONLY for Villages that qualify for the Colony Center?

Well said Kahuna....I have been in practice for 40 years and have seen several models evolve....I would had loved to be a part of the discussion process of this development.
It is vital to attract exceptional doctors....this can be done if it is a priority.
The trick is defining the type of doctor you want and being able to attract them.
You must pay them well and make their work environment something special.
I know this can be done at TV and hope they are successful....I will be following the progress with great interest.