Coastal Emergency Services has signed a multiyear capitated contract to provide emergency and primary care to Humana Health Plans of South Florida enrollees in Miami.
The contract, which begins this Emergency care month, is one of the first known capitated managed-care contracts outside of California to link emergency and primary-care services.
California Emergency Physicians, Oakland, has been offering capitated contracts in Southern California for nearly two years through its 325 emergency physicians and 35 primary-care doctors, said Michael Bellick, CEP's director of administration.
Humana also is expected to sign a separate capitated contract for inpatient services with Columbia Healthcare Corp.'s 258-bed Miami Heart Institute, said Joseph Berding, a Humana vice president.
"If this works out, we'd like to extend it to all 15 of our hospitals (in South Florida)," said Daniel Moen, president of Columbia's South Florida division.
Through Gold Star Management Company, a newly acquired Coastal subsidiary, Coastal will provide 25 primary-care physicians, four emergency physicians at Miami Heart and several internists to service the Humana contract, said David Singley, Coastal's chief operating officer.
Under terms of the contract, Gold Star will receive a single annual payment to treat Humana's 12,000 Medicare HMO patients when they present themselves at Miami Heart or Gold Star's 12 clinics, Mr. Singley said.
Coastal executives declined to divulge the amount of the contract. However, Humana will pay Gold Star a per member per month fee for its services.
Emergency physicians have been leery about signing capitated contracts because they have no control over patients entering emergency departments, said Norm Schneiderman, M.D., medical director of the emergency department at 642-bed Miami Valley Hospital, Dayton, Ohio.
"That could change if primary physicians are linked in a contract," said Dr. Schneiderman, an adviser to the American College of Emergency Physicians.
Coastal, like California Emergency Physicians, has combined primary-care and emergency physicians into the capitated contract so patients can be directed to the least expensive setting.