CFO Intelligence Magazine – Fall 2022
Barry Lederman
Perimeter Solutions CFO
With more than 1.8 million members, and over $14 billion in premiums for 2021, Healthfirst is the New York City area’s largest not-for-profit health insurer. The organization offers high-quality, affordable plans to fit every life stage, including Medicaid plans, Medicare Advantage plans, long-term care plans, qualified health plans, and individual and small group plans, according to CFO John Bermel. Healthfirst has maintained its leading position through innovation and strong community engagement, he adds.
A SHARED APPROACH DRIVES COST SAVINGS
To do this successfully, Healthfirst’s medical provider partners share data with the insurer, “so we can evaluate it and help hospitals and physicians to gain a better understanding of their performance,” says Bermel. “We capture financial and outcome data at the member level, and then our analytics teams scour it to understand the providers’ performance and make improvement suggestions.”
For a typical at-risk hospital, for example, Healthfirst maintains detailed subP&Ls that make it easier to analyze revenue and expenses on a risk-adjusted basis by such categories as inpatient, outpatient, physician, and pharmacy, he details. “This data is submitted as encounters to the state,” says Bermel. “Also, as a Medicare and Medicaid insurer, Healthfirst may qualify for government incentives based on quality scores — we have been routinely ranked as a top-tier organization — and we then share those incentive payments with our medical provider partners.”