Capital Health Plan

What it reported doing in 2024

Background and mission: capital health plan is a local hmo focused on serving the 9 counties that constitute the tallahassee, Florida metropolitan area. The health plan's vision is to be nationally recognized quality, locally trusted, and affordable healthcare. The health plan's mission: as a not-for-profit hmo, we exist to improve the health of our communities by providing high quality, comprehensive health plans with low administrative costs, through primary care focused, patient-centered healthcare.in pursuing the mission, capital health plan impacts the health and well being of tallahassee area residents - both those who are plan members and those who are not.chp serves a membership base of 136,000 people; over 34% of the area's population. The health plan has developed a high quality delivery system that includes over 800 area physicians, more than 90% of the medical community. The core of this delivery system is chp's employed clinical staff, a group of 32 physicians and 8 optometrists who practice in three state-of-the-art health centers the plan has developed. These health centers are equipped with electronic medical records and can accommodate a broad range of primary and specialist care services including evening and weekend urgent care, lab, skin and wound care center, infusion clinic, digital x-ray and mammography services. Chp's ability to offer a highly organized component of its delivery system to its members has provided unique opportunities for improving health care outcomes. The staff component of chp's delivery system consistently produces better results on measures of clinical care, member satisfaction and efficiency.capital health plan seeks to lead our area and continually improve performance against benchmarks for clinical quality, member satisfaction, and affordability. Our focus on quality of care is evidenced by our member satisfaction and quality ratings from both ncqa and cms, where chp has consistently been rated as the best plan in Florida and one of the best in the country. In addition, as stewards of our member's premium dollars, chp returned roughly 97 cents of every premium dollar to deliver healthcare services to our members. This concentration on quality and affordability is combined with a continuous effort by our medical leadership, in concert with physicians and other providers in the community, to identify and act upon opportunities to lower costs while maintaining quality. By being our area's market leader, capital health plan attempts to raise the bar for providing value in health care throughout our community. In addition to these marketplace impacts, chp directly invests in the community it serves through a formal community benefit policy adopted by its board of directors. The policy focuses the organization's community benefit initiatives in three primary areas: addressing market failures- chp will be a leading partner in the tallahassee area in addressing the needs of the uninsured and underinsured.promoting community health - chp will transform its heritage in population-based health to pursue strategies that go beyond traditional medical care to impact the health of the entire tallahassee community.clinical training/research- chp will partner with the educational institutions in our area to help train the clinical workforce our community will need in the future and to maximize an evidence-based focus on population health in training and research.capital health plan's commitment to community benefit represents a social dividendderived from the organization's ongoing focus on excellent clinical care and service to its members.2024 accomplishments and benefit to the communityhighlights of capital health plan's contributions to the health of the tallahassee area in 2024 include the following: affordabilitycapital health plan's commercial premium yield increased 5.8% for 2024. Chp has maintained 20 consecutive years of single digit price adjustments. These low price adjustments were a

Financial Efficiency

• Mission deployment rate: 94.1%; rating input score 94
• Program expense ratio: 96.3%; rating input score 96
• Fundraising efficiency: Limited

Transparency & Controls

• Consistency checks: 92.9%; rating input score 93; 17th percentile among comparable filings
• Pay-setting controls: 6 of 6 controls in place; rating input score 100
  • Compensation committee: Pass
  • Independent consultant: Pass
  • Other Form 990s reviewed: Pass
  • Written employment contract: Pass
  • Compensation survey or study: Pass
  • Board or committee approval: Pass
• Foreign activity oversight: Limited
• Grant itemization coverage: 97.6%; rating input score 98; 33rd percentile among comparable filings
• Major donor itemization: Limited
• Related-party transparency: Limited

Accountability

• Independent voting board: 86.7%; rating input score 87; 33rd percentile among comparable filings
• Governance controls: 9 of 9 controls in place; rating input score 100
  • Conflict-of-interest policy: Pass
  • Whistleblower policy: Pass
  • Document-retention policy: Pass
  • CEO compensation review process: Pass
  • Other executive compensation review process: Pass
  • Form 990 shared with the board: Pass
  • Board meeting minutes documented: Pass
  • Audit committee oversight: Pass
  • Independent financial-statement audit: Pass

Sustainability

• Operating margin: 0.9%; rating input score 37; 37th percentile among comparable filings
• Total-asset coverage ratio: 0.64; rating input score 25; 25th percentile among comparable filings
• Liabilities to assets ratio: 0.2; rating input score 69; 69th percentile among comparable filings
• Officer compensation ratio: 0.9%; rating input score 77; 77th percentile among comparable filings

Growth

• Program expense growth: 5.2% per year; rating input score 100; 43rd percentile among comparable filings
• Revenue growth: 4.9% per year; rating input score 100; 42nd percentile among comparable filings
• Asset growth: 4.9% per year; rating input score 100; 36th percentile among comparable filings