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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

Integrating Independent Physicians into an Accountable Care Organization

Keywords: Advocate Physician Partners, Advocate Health Care, accountable care organizations, asthma, care coordination, care management, Illinois, intensive care, independent physician associations, performance improvement, prevention, physician and hospital collaboration, value

Advocate Physician Partners, a joint venture representing approximately 3,500 physicians serving patients in Illinois, could serve as a model for a new kind of ACO. Advocate Physician Partners is affiliated with Advocate Health Care, a not-for-profit faith-based health system in northern and central Illinois. By organizing physicians into partnerships with hospitals to improve care and be held accountable for the results, Advocate Physician Partners has addressed the most significant barriers to creating an effective ACO, and has also has made impressive strides in quality and outcomes.


A Model for Integrating Independent Physicians into Accountable Care Organizations

The online version of this article by Mark C. Shields, Pankaj H. Patel, Martin Manning, and Lee Sacks is available at:

http://content.healthaffairs.org/content/30/1/161.full.html

The Affordable Care Act encourages the formation of accountable care organizations (ACO) as a new part of Medicare. At this point, however, it is unclear precisely how these ACOs will be structured. Although large integrated care systems that directly employ physicians may be most likely to evolve into ACOs, few of these truly integrated systems exist in the United States.

Advocate Physician Partners, a joint venture representing approximately 3,500 independent physicians serving patients in Illinois, could serve as a model for a new kind of ACO. Advocate Physician Partners is affiliated with Advocate Health Care, a not-for-profit faith-based health system in northern and central Illinois. For more than fifteen years, the partnership between physicians and Advocate has performed care management and managed care contracting. By organizing physicians into partnerships with hospitals to improve care and be held accountable for the results, Advocate Physician Partners has addressed the most significant barriers to creating an effective ACO. It has also has made impressive strides in quality and outcomes.

Advocate Health Care hospitals invested more than $10 million in the technology of a centralized command center for all 250 adult intensive care beds in eight of its ten acute care hospitals. Staffed around the clock by board-certified intensivists, the initiative allows these specialists to make immediate changes in patients’ treatment based their condition, without waiting for the approval of attending physicians. In this way, new drugs, procedures, or therapies can be applied immediately, without delays. As a result, mortality for adult intensive care patients has decreased steadily since the program was implemented in 2003.

As part of a comprehensive program for care of asthma patients, the partnership has implemented standardized asthma action plans for home management, individualized for specific patients. In 2009, the partnership implemented action plans for 83 percent of its asthma patients. This number was three times greater than the national average, according to a study that showed only 26 percent of controlled asthma patients and 35 percent of uncontrolled asthma patients received such a plan from their physicians. And the partnership’s results typically exceed the National Committee for Quality Assurance’s measures for management of blood sugar, cholesterol, and blood pressure.

FOR MORE INFORMATION:

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