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Niche Clinic Operator Moves Headquarters to OC

Concerto Healthcare Inc., a healthcare provider catering to senior citizens, has moved its corporate headquarters to Irvine from Schaumburg, Ill.

Concerto delivers healthcare to individuals who are eligible for both Medicaid and Medicare, a pair of government-funded insurance programs.

The company provides clinic services in a niche of the market made up of “those who can get to the clinics, in-home services for those who can’t, and we have field-based care teams that can follow our members through any other healthcare setting,” said Concerto Chief Executive Alec Cunningham.

Concerto is serving a population that is not large but heavily uses healthcare services. The company notes that dual-eligible patients—those eligible for both Medicaid and Medicare— account for more than $300 billion in healthcare spending annually.

Figures from the federal Medicaid-Medicare Coordination Office show that the total number of dual-eligible Americans grew 18% from 8.6 million to 10.2 million between 2006 and 2011. That number is expected to increase in coming years with the expansion of Medicaid eligibility through federal healthcare reform and the aging of the baby boom generation.

“Healthcare reform has really created substantial opportunities for us,” Cunningham said, noting that those opportunities include millions of additional insured people, as well as some pilot programs for treating dual-eligibles.

Concerto’s business model includes three prongs:

&#8226 Medical centers staffed by doctors, nurses, social workers, medical assistants and pharmacists, as well as social and community service support, patient outreach and health education.

n Healthcare coordination, including in-home care, bedside patient management if a patient is in a hospital or post-acute care setting, and managing the transitions between patients’ care settings.

n Managing chronic diseases, providing comprehensive preventive screenings, non-emergency transportation and prescription assistance—Concerto says a lack of those services “are key barriers to healthcare [usage].”

Concerto made the move to OC because of “a very unique and attractive talent pool” here, said Cunningham, who also credited Southern California as a regional “center for healthcare innovation.”

He added that Concerto’s team will be enhanced by what he called “seasoned healthcare entrepreneurs and operators.”

Concerto projects it will have 285 workers by the end of the year, 128 of whom will be based in Irvine. It also operates in Detroit and Seattle.

“We support all of our operations from Irvine, so as we expand nationally, there will be continued growth in Orange County,” Cunningham said.

The company is privately held and does not disclose financial results. Its investors include Versant Venture Management LLC, which has an office in Orange County, and Ann Arbor, Mich.-based Arboretum Ventures.

Cunningham said some companies have operations that compete with parts of Concerto’s business lineup but said “… We have all three elements of the program and technology that connects all of it.”

Concerto’s move also comes with a strategy shift and a name change. It was previously known as Fidelis SeniorCare and was also deeply involved in Medicare Advantage managed care plans in addition to its other services.

Concerto sold its Medicare Advantage health plans to Austin, Texas-based FHP Insurance Holding Co. and St. Louis-based Centene Corp. earlier this year.

“We are excited with our strategic pivot out of the insurance business,” said Cunningham, who previously was chief executive of Tampa, Fla.-based WellCare Health Plans. He came to Concerto last year.

Cunningham said Concerto’s strategic change has also led it to pick up managers with deep industry experience.

Michael Carson, Concerto’s chief operating officer, was formerly president of Indianapolis-based Anthem Inc.’s Eastern region Medicare business. Chief Financial Officer Toby Thomas was previously CFO of Nashville, Tenn.-based Cogent Healthcare Inc., which was once based in Irvine.

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