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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

HomeCare Program Delivers Coordinated Care to High Risk Patients at Home

HealthCare Partners believed that high risk patients could have better medical outcomes if cared for in a home setting using an interdisciplinary team approach that focuses on both the patient and his/her family and caregivers. To better care for its highest risk patients, HealthCare Partners Medical Group implemented a HomeCare Program in 2008. The program uses an interdisciplinary team approach to provide coordinated care to patients, with a focus on including the patient’s family and caregivers. The goal of the program is to improve the quality of life and clinical outcomes for homebound and other high risk patients.

Patients are referred into the HomeCare Program by our primary care physicians, hospitalists, and specialists. To identify the initial group of patients to be seen as part of the HomeCare Program, HealthCare Partners also used a health plan stratification tool. The target population may not always be physically homebound, but may have complex psycho-social needs that require in-home management.

Services and goals of the HomeCare Program may include acute medical management after a hospitalization or skilled nursing facility stay, management of chronic medical conditions, assistance with complex social situations, advanced care planning, and a change in living arrangements for some patients.

The program’s current staffing model includes two physicians, two nurse practitioners, one social worker, and two medical assistants to manage a panel of approximately 360-400 patients. A clinician initially sees each patient for a 90-minute consultation, and then the patient is seen monthly on a routine basis, and urgently as needed. Patients, families, and referring physicians are given 24/7 direct telephone access to the HomeCare team.

Clinicians are able to complete medical record documentation in the patient’s home using a laptop with a wireless connection to our Electronic Medical Record system. The HomeCare team holds weekly meetings to review patient status, treatment, and progress, and to determine follow-up needs. Pharmacists, geriatricians, and behavioral health providers participate in the team meetings as needed.

To maximize the effectiveness of the HomeCare Program, the HomeCare team continues to work closely with the patients’ primary care physicians, specialists, and hospitalist teams. The HomeCare team has access to a rich database of claims, pharmacy, and electronic medical record data, which provides point-of-care evidence-based reminders for preventive and chronic care needs to enhance the clinical outcome for these high risk patients.

The program’s success is measured on such dimensions as patient satisfaction, chronic disease measures (e.g., LDL, HbA1C, blood pressure, acute hospital admits, acute hospital days, ER visits, Urgent Care visits, and PCP visits), and overall cost of care compared to a control population.

Keywords: HealthCare Partners Medical Group, HCP, coordinated care, homecare, home care, homebound, high risk patient, care team, electronic medical record, electronic health record, EMR, EHR, evidence-based medicine, health information technology, hospital readmission, integrated care, medical management, treatment

FOR MORE INFORMATION:

Robert Klein
HealthCare Partners Medical Group
19191 S. Vermont Avenue
Torrance, CA 90502
tel. 310.630.4126
rjklein@healthcarepartners.com
www.healthcarepartners.com