ello Health Plan Archives | CAPP
Share your opinion about American healthcare
Take our poll

Population Health Management in an IPA: Monarch HealthCare ACO Pilot Program

In 2009, Brookings–Dartmouth launched its ACO Pilot Program to support four provider groups to form accountable care organizations (ACOs) with health plans and private payers (as opposed to the Medicare government-supported ACO programs now underway). The provider organizations that are participating all agreed to take responsibility for the overall cost and quality of care for their patients, with their private payer partner.

The organizations chosen are Monarch HealthCare, an IPA in Orange County, CA; HealthCare Partners, a medical group/independent practice association (IPA) based in Los Angeles, CA.; Norton Healthcare, an integrated delivery system in Louisville, KY; and Tucson Medical Center, a community hospital working with independent provider groups in Tucson, AZ.

This preliminary case study conducted by the Commonwealth Fund with Brookings-Dartmouth describes Monarch Healthcare’s experience to date and how the IPA is leveraging its expertise in population health management to achieve.


Population Health Management in an IPA: Monarch HealthCare’s ACO Pilot Program

Monarch Healthcare, Irvine, California

In 2009, Brookings–Dartmouth launched its ACO Pilot Program to support four provider groups to form accountable care organizations (ACOs) with health plans and private payers (as opposed to the Medicare government-supported ACO programs now underway). The provider organizations that are participating all agreed to take responsibility for the overall cost and quality of care for their patients, with their private payer partner.

The organizations chosen are Monarch HealthCare, an IPA in Orange County, CA; HealthCare Partners, a medical group/independent practice association (IPA) based in Los Angeles, CA.; Norton Healthcare, an integrated delivery system in Louisville, KY; and Tucson Medical Center, a community hospital working with independent provider groups in Tucson, AZ.

This preliminary case study conducted by the Commonwealth Fund with Brookings-Dartmouth describes Monarch Healthcare’s experience to date. In this report, the researchers discuss the factors that have contributed to the success­ful development of Monarch’s ACO, which include strong executive leadership, trust and transparency in partnerships, the use of care navigators and physician champions, and economies of scale across the IPA’s physician network. Monarch’s long history in managing care through their strong primary care network for their senior population through Medicare Advantage is also cited as being a competency fundamental to ACO development and success.

For the complete report, please click here.

For a complete list of case studies in this Commonwealth Fund series, along with an introduction and description of methods, please click here.

FOR MORE INFORMATION:

Nancy Taylor
Executive Director
Council of Accountable Physician Practices
nancy.taylor@amga-capp.org
www.amga-capp.org

Improving Care and Reducing Costs for PPO Patients: HealthCare Partners ACO Pilot Program

In 2009, Brookings–Dartmouth launched its ACO Pilot Program to support four provider groups to form accountable care organizations (ACOs) with health plans and private payers (as opposed to the Medicare government-supported ACO programs now underway). The provider organizations that are participating all agreed to take responsibility for the overall cost and quality of care for their patients, with their private payer partner.

The chosen organizations are HealthCare Partners, a medical group/independent practice association (IPA) based in Los Angeles, CA.; Monarch HealthCare, an IPA in Orange County, CA; Norton Healthcare, an integrated delivery system in Louisville, KY; and Tucson Medical Center, a community hospital working with independent provider groups in Tucson, AZ.

This preliminary case study conducted by the Commonwealth Fund with Brookings-Dartmouth describes the HealthCare Partners’ experience to date.


Improving Care and Reducing Costs for PPO Patients: HealthCare Partners’ Brookings–Dartmouth ACO Pilot Program

HealthCare Partners, Los Angeles, California

In 2009, Brookings–Dartmouth launched its ACO Pilot Program to support four provider groups to form accountable care organizations (ACOs) with health plans and private payers (as opposed to the Medicare government-supported ACO programs now underway). The provider organizations that are participating all agreed to take responsibility for the overall cost and quality of care for their patients, with their private payer partner.

The organizations chosen are HealthCare Partners, a medical group/independent practice association (IPA) based in Los Angeles, CA.; Monarch HealthCare, an IPA in Orange County, CA; Norton Healthcare, an integrated delivery system in Louisville, KY; and Tucson Medical Center, a community hospital working with independent provider groups in Tucson, AZ.

This preliminary case study conducted by the Commonwealth Fund with Brookings-Dartmouth describes the HealthCare Partners’ (HCP) experience to date. In this report, the researchers reveal the characteristics of HCP and its partner organizations, including Anthem, the payer partner; the organization’s decision to develop an ACO; the steps that HCP has taken to implement the model; as well as the achievements and lessons learned as of this writing.

This report discusses how HCP’s success thus far is attributable to its strong primary care base; culture of accountability; emphasis on prevention and promotion; sophisticated integrated health information technology; care management and care coordination processes; performance measurement and reporting; and experience with risk-based contracts with payers.

For the complete report, please click here.

For a complete list of case studies in this Commonwealth Fund series, along with an introduction and description of methods, please click here.

FOR MORE INFORMATION:

Robert Klein
HealthCare Partners
VP Communications and Marketing
310-630-4126
rjklein@healthcarepartners.com
www.healthcarepartners.com

Virginia Mason Provider-Employer-Payer Collaboratives Target Common Medical Conditions

Virginia Mason Medical Center in Seattle has worked in collaboration with health plans and employers to develop standardized approaches to the care of patients with common medical conditions. Called marketplace collaboratives, these efforts have eliminated unnecessary treatment and decreased costs to employers, health plans, patients, and providers while improving quality and value. To date, Virginia Mason has implemented clinical value streams for low back pain, headache, large joint pain, and breast concerns not related to cancer screening. The strides made in quality by this approach have been impressive.


Excerpted from:

At Virginia Mason, Collaboration Among Providers, Employers, and Health Plans to Transform Care Cut Costs and Improved Quality, by C. Craig Blackmore, Robert S. Mecklenburg, and Gary S. Kaplan

http://content.healthaffairs.org/content/30/9/1680.full.html

Virginia Mason Medical Center in Seattle has worked in collaboration with health plans and employers to develop standardized approaches to the care of patients with common medical conditions. Called marketplace collaboratives, these efforts have eliminated unnecessary treatment and decreased costs to employers, health plans, patients, and providers while improving quality and value.

The initial task of the first marketplace collaborative was to define quality. After much deliberation, the collaborative participants decided that quality related to five key factors: patient satisfaction; the practice of evidence-based care; rapid access to care by patients; patients’ rapid return to functioning; and cost. Once the definition of quality was determined, the next step was to identify the optimal, evidence-based care for low back pain, the focus of the first collaborative. Each subsequent marketplace collaborative has selected a different condition to target for improvement. Called “clinical value streams,” these standardized clinical pathways ensure that best practices are followed and unnecessary test and treatments are eliminated.

To date, Virginia Mason has implemented clinical value streams for low back pain, headache, large joint pain, and breast concerns not related to cancer screening. The strides made in quality by this approach have been impressive. For instance, the headache clinical value stream focused on patients with uncomplicated headache in which no other symptoms of concern were present, such as head trauma or fever. These patients typically do not require expensive imaging tests, but many were receiving them anyway. Through the collaborative process, Virginia Mason decreased the use of MRIs by 23 percent, so delays in seeing a doctor because of pending test results were minimized. New policies were implemented that allowed patients to get in to see a doctor the same day as their headache developed in 95 percent of cases. The result has been that patients with headache now score their care at an impressive 91 in terms of patient satisfaction.

At Virginia Mason, collaborative efforts among providers, payers, and employers have lead to improved care delivery according to a common definition of quality. By developing and implementing evidence-based care pathways, quality parameters are being achieved by a decrease in unnecessary care and costs, and with high patient satisfaction and rapid access.

Keywords: access, evidence-based care, clinical pathways, headache, large joint pain, low back pain, quality improvement, payer collaboration, employer collaboration, clinical value streams, marketplace collaborative, Virginia Mason Medical Center, Seattle, Washington.

FOR MORE INFORMATION:

Michelle Peterson
Director, Communications and Public Relations
Virginia Mason Medical Center
100 Ninth Ave, MS GB-ADM
Seattle, WA 98101
(206) 583-6581
michelle.peterson@vmmc.org
http://www.VirginiaMason.org/

HealthPartners: Closing the Gap in Health Care Disparities (Colorectal Cancer)

Colorectal cancer deaths are 48 percent higher among African-Americans than among whites, according to the US Department of Health & Human Services. As a result, HealthPartners developed customized interventions aimed at reducing disparities in colorectal cancer screening rates for African-American patients.


More than ten years ago, HealthPartners began groundbreaking work to close a gap in health care and ensure that care and service is of equally high quality for all populations, regardless of a patient’s race or ethnicity, preferred language, private insurance or public program. To identify and address these disparities, HealthPartners leaders established the Cross Cultural Care and Service Task Force in 2001, and, in 2003, the health system developed a plan to collect self-reported patient demographic data to assist in creating strategies and tactics to improve care and service for our patients.

Reduction of colorectal cancer screening disparities for African-American patients

Colorectal cancer deaths are 48 percent higher among African-Americans than among whites, according to the US Department of Health & Human Services. As a result, HealthPartners developed customized interventions aimed at reducing disparities in colorectal cancer screening rates for African-American patients.

In 2009, based on new national guidelines and guidelines from the Institute for Clinical Systems Improvement (ICSI), a nonprofit collaborative, HealthPartners expanded the eligible population for colorectal cancer screening to include African-Americans and Native Americans at age 45 instead of 50, which added more than 1,000 HealthPartners patients who needed screening.

To screen additional patients and to close the gap, HealthPartners developed several customized interventions, including:

  • Using the race information provided by patients and the electronic medical record to automatically generate reminders to African-American and Native American patients and providers to have colorectal screening beginning at age 45
  • Telephone outreach to patients who were eligible for screening
  • The option of a fecal immunochemical (FIT) test, an evidence-based alternative to colonoscopy. The electronic medical record provides a shared decision making tool for our provider to offer the FIT test for patients who prefer it over colonoscopy.

These interventions are saving lives by improving screening disparities by payer (as a measure of socioeconomic differences) and by race. HealthPartners has seen a 27 percent improvement in colorectal screening rates for African American patients since implementation. Even with the population expansion, HealthPartners screening rates continue to rise rapidly, and are already above the 2010 HEDIS 50th percentile rankings.

measure

HealthPartners: Closing the Gap in Health Care Disparities (Breast Cancer)

HealthPartners has made significant progress toward reducing the disparity in breast cancer screening rates between white women and women of color. In 2007, the screening disparity between white women and women of color was nearly 13 percent. Since then, the disparity has closed to an average under 5 percent and, at several HealthPartners clinics, the rates are nearly identical or better in patients of color.


More than ten years ago, HealthPartners began groundbreaking work to close a gap in health care and ensure that care and service is of equally high quality for all populations, regardless of a patient’s race or ethnicity, preferred language, private insurance or public program. To identify and address these disparities, HealthPartners leaders established the Cross Cultural Care and Service Task Force in 2001, and, in 2003, the health system developed a plan to collect self-reported patient demographic data to assist us in creating strategies and tactics to improve care and service for our patients.

Reduction in breast cancer screening disparities for women of color

HealthPartners has made significant progress toward reducing the disparity in breast cancer screening rates between white women and women of color. In 2007, the screening disparity between white women and women of color was nearly 13 percent. Since then, the disparity has closed to an average under 5 percent and, at several HealthPartners clinics, the rates are nearly identical or better in patients of color.

To achieve this, HealthPartners developed customized interventions addressing barriers affecting minority populations to better serve patients. For some women, the extra encouragement from the doctor or care team during a clinic visit made obtaining the screening more likely. HealthPartners responded with a same-day mammography program in which patients overdue for a mammogram are offered the service when at the clinic for some other reason. Other interventions include transportation assistance, telephone outreach and special scripting for providers.

mammo

FOR MORE INFORMATION:

Amy von Walter
Director, Corporate Communications
HealthPartners
8170 33rd Avenue South
Bloomington, MN 55425
tel. 952.883.5274
amy.e.vonwalter@healthpartners.com
www.healthpartners.com