California Medical Group – IPA Merges with a Dialysis Firm – Deal Value $4.4 Billion

Healthcare Partners, Torrance, CA, one of the nation’s largest physician organizations, a medical group and IPA with 152 medical clinics and offices, has entered into an agreement to merge with DaVita, Inc. in a $4.4 billion deal.

The physician organization serves some 700,000 patients in three states, Southern California, Central Florida, and Southern Nevada.

Healthcare Partners Medical Group comprises 700 primary care and specialists and the organization’s IPA has 900 contracted primary care and 3000 specialist physicians.

DaVita, a provider of kidney care services runs dialysis clinic specialist.

Over the years the MCIC has been covering Health Partners and its growth for ongoing research for the National Directory of Physician Organizations Database.

Links: http://www.healthcarepartners.com/

http://www.healthresourcesonline.com/managed_care/23poe.htm

Almost Half of U.S. Physicians Are on Medical Staffs of the Nation’s Healthcare Systems Hospitals

Some 439,269 physicians are members of the medical staffs of the nation’s largest hospital organizations, Managed Care Information Center research has found.

The figure represents 46 percent of the 954,000 U.S. physicians which the AMA cites as the number of doctors in the country.

Among the physicians almost 260 thousand are primary care physicians and 179,568 are specialists, found the review of the National Directory of Health Systems, Hospitals and Their Affiliates database.

The National Directory of Health Systems, Hospitals and Their Affiliates Database is researched, compiled and produced by the Managed Care Information Center.

The database focus is on the largest hospital operators in the country – the health systems.

The database provides key contact information, names, addresses and other details on the more than 750 major health systems in the United States, the almost 3500 health systems hospitals and more than 12,000 hospital system affiliated provider organizations.

We find the health system affiliates are continuing to grow in numbers.

The system affiliations includes: hospitals, medical centers, community care centers, hospices, nursing homes, ambulatory care centers, clinics, surgical centers, imaging centers, wellness and health promotion programs, and other providers of healthcare.

We believe that the list of affiliates provides sound information for sizing a market area and the health systems impact in a market area.

Information on The National Directory of Health Systems, Hospitals and Their Affiliates is found at: www.healthresourcesonline.com/managed_care/17idse.htm

 

 

 

New Physician Organization Leadership Survey Seeks Insight – Opinion

The Managed Care Information Center periodically conducts our Physician Organization Leadership Survey to identify the issues, challenges and opportunities today for physician organizations.

We are seeking survey responses from those engaged in the management and administration of or who are members of such physician organizations as IPAs, PHOs and MSOs.

For your participation in this brief survey, we will send you free an executive summary of the analyzed results.

What are the ‘looming’ challenges? Any opportunities? What is the most pressing concern from your perspective?

The survey only takes a few moments. You do not have to identify yourself if you choose.

As you know, survey results are reported in the Managed Care Information Center reports, in our Managed Care Weekly Watch, as well as the MCIC Blog, Facebook and Twitter and are posted at our website.

To participate in this survey, go click on this link now: http://bit.ly/JhFn9o

If you are connected with executives of members of PHOs, IPA or MSOs, please let them know about this survey.

Members in Consumer-driven Health Plans Seen More Educated, Healthier, Wealthier

New findings of a study of members enrolled in consumer driven health plans has found that those individuals tend to have higher incomes, higher educational levels, and report better health behavior than do those in traditional health plans.

The report was produced by the nonpartisan Employee Benefit Research Institute (EBRI). The study examined trends over the 2005–2011 period.

Consumer-driven health plans (CDHPs) generally consist of high-deductible health plans (HDHP) with either a health reimbursement arrangement (HRA) or Health Savings Account (HSA).

As of 2011, some 21 million individuals, representing about 12 percent of the market, were either in a CDHP or an HSA-eligible health plan, the report said.

“Consumer-driven health plans are a growing presence in the health insurance market, so it’s important to understand how they differ from traditional health plans,” observed Paul Fronstin, author of the report and director of EBRI’s Health Research and Education Program.

He said it is “often assumed that CDHP enrollees are more likely to be young than those with traditional coverage, because they use less health care, on average. However, in most years, the survey found that CDHP enrollees were less likely than those with traditional coverage to be between the ages of 21 and 34.”

Other findings from the EBRI report include:

  • CDHP enrollees were roughly twice as likely as individuals with traditional coverage to have a college or post-graduate education. HDHP enrollees were also more likely than traditional-plan enrollees to have a college or graduate degree.
  • CDHP enrollees have consistently reported better health status than traditional-plan enrollees.
  • During the survey period, HDHP enrollees have been consistently less likely than those with traditional coverage to report that they smoke, but no recent differences were found in exercise rates, and differences were not found in obesity rates.

For more information following is a link to EBRI’s news release:

http://www.ebri.org/pdf/PR968.26Apr12.CDHPs.pdf

What Exactly Is An Integrated Healthcare Delivery System?

What exactly is an integrated healthcare delivery system is a question we are asked fairly regularly. Even today, many individuals are not sure what the term refers to.

(We know because we produce the National Directory of Health Systems Hospitals and Their Affiliates Database.)  https://www.healthresourcesonline.com/payer-provider-data/the-national-directory-of-health-systems-hospitals-and-their-affiliates.html

What callers have trouble grasping is the ‘affiliate’ piece. There are more than 11,500 affiliates that are a significant part of the health system.

We call the health systems the ‘motherships’ and all the affiliates are under the health system umbrella.

To be recognized as a true integrated healthcare delivery system or network – your preference – industry experts agree there must be a number of key elements present, including the philosophy of a “systemness” — certain system-wide functions and decision-making authority.

There must be a common philosophy among network entities to provide a “seamless continuum of care” — the opportunity to offer the community or region expanded and complimentary health services, and elimination of duplicative service programs.

To achieve this “seamless continuum of care” an integrated healthcare delivery system must provide a full range of healthcare services to a market area that is comprised of physicians, clinics, hospitals, a referral network, and a diverse offering of after-care services.

An integrated healthcare delivery system may operate its own managed care organization (MCO) or may wholesale the provision of care services and seek to accept risk within components of the systems, such as a physician network or its hospitals.

The National Directory of Health Systems, Hospitals and Their Affiliates Database is researched, compiled and produced by the Managed Care Information Center.

Our database provides key contact information, names, addresses and other details on the more than 750 major health systems in the United States, the almost 3500 health systems hospitals and more than 11,700 hospital system affiliates.

http://www.healthresourcesonline.com/managed_care/17idse.htm

Lessons From Florida – The Patient-Centered Medical Home: Statewide Rollout

A primary care focused pay-for-performance program at Florida Blue has been transitioned this year into a statewide patient-centered medical home initiative.

While the Recognizing Physician Excellence program (RPE) program had moved the bar on quality metric performance, the move to the PCMH provides a look at both the quality and efficiency factors of a patient’s care.

An under-the-hood look into the details of this successful new program will be presented during The Patient-Centered Medical Home: Lessons from a Statewide Rollout, a 45-minute webinar on May 10th at 1:30 pm Eastern, Barbara Haasis, R.N., CCRN, senior clinical lead, quality reward and recognition programs at Florida Blue, will share how the health plan transitioned from the RPE program into a medical home model.
She will share:

  •     Lessons learned from the first year of a PCMH pilot program and how this shaped the statewide rollout;
  •     The criteria for which physician practices were selected to participate in the program;
  •     The shared savings approach through which practices will be reimbursed;
  •     The role of a nurse educator in helping the practices transform;
  •     Reporting practice results to drive further improvement;
  •     Results in total cost of care from physicians originally enrolled in the pay-for-performance program, now in the first quarter of the PCMH.

For more information or to register, please contact call 800-516-4343 or click on this link now: http://store.hin.com/product.asp?itemid=4401

Are MCOs adequately addressing member satisfaction needs?

Related to the member communication initiatives of MCOs is meeting member\patient satisfaction.

So are health plans addressing patient satisfaction as a top priority?

This is question, from our Managed Care Leadership Survey, stirs strong opinions from providers, payers and others.

For instance: “No. Major carriers are doing just enough to maintain their satisfaction levels. They are also building their own satisfaction surveys to give the impression that they are top notch. A better way would to use a consistent measure like CAHPS to monitor.”

“Yes. New rules and bonus payments”

“No. Too little in the way of real tools, peer to peer assistance”

“No. Growing limits on provider access and increased carveouts are creating growing member dissatisfaction.”

“Yes. Adequately, yes. Meeting expectations, probably not. All depends on the benchmarks one is willing to use to measure member satisfaction.”

Source: Managed Care Information Center