Accountable-care organizations are slowly taking root in Orange County.
The organizations bring doctors, hospitals and insurers together on efforts to cut costs through greater efficiencies while maintaining quality standards.
They gained momentum with 2010’s federal healthcare, bringing medical groups such as Irvine-based Monarch HealthCare, A Medical Group Inc. into the trend.
Monarch has one accountable care organization up and running to work with Medicare, the federal insurance program that serves elderly Americans.
“We went live on Jan. 1 [and are serving] 17,000 Medicare beneficiaries in Orange County,” said Jay Cohen, Monarch’s chairman and president. It has another accountable care organization for patients with private healthcare plans in the works.
ACOs
Monarch is one of 32 medical groups in 18 states working with Medicare to rein in costs through accountable care organizations. The federal agency pays directly for healthcare delivered through the accountable care organizations, which offer doctors and hospitals a share of any savings if 35 quality benchmarks are met.
Monarch’s other accountable care organization aims to build on a partnership with Brookings Institution’s Engelberg Center for Health Care Reform and Dartmouth Institute for Health Policy. Insurer Anthem Blue Cross, a unit of Indianapolis-based WellPoint Inc., was scheduled to be one of the payers in the project but withdrew in the fall in a contract dispute with Monarch.
Officials now are in the hunt for an insurer to replace Anthem on the project.
Orange-based St. Joseph Health System, which operates four OC hospitals, launched its own commercial accountable care organization on Jan. 1 in collaboration with San Francisco-based Blue Shield of California. Some 30,000 Blue Shield HMO members now have their healthcare managed through the organization, with the St. Joseph system and insurer sharing clinical and case management information to coordinate healthcare services.
Participants
St. Joseph Hospital-Orange, St. Jude Medical Center in Fullerton, and Mission Hospital—which has campuses in Mission Viejo and Laguna Beach—are participating in the initiative, along with the St. Joseph Home Health Ministry, three affiliated physician networks and other medical groups.
St. Joseph wanted to work with Blue Shield because it understands the importance of providing healthcare “that optimizes clinical quality, patient safety and patient experience,” said C.R. Burke, president of St. Joseph Heritage Healthcare, one of the medical groups that is part of the health system.
Irvine-based employee benefits consultancy Precept Group is working on a variation of accountable care organizations that’s been dubbed accountable-care communities. The plans are driven by employers rather than insurers, but also can include hospitals, insurers and doctors.
“True Players”
Reggie Townsend, a Precept consultant, said accountable-care communities are based on the premise that employers are “the true payers in this whole scheme of healthcare.”
The emphasis on consumer education is tied to the notion that consumer behavior must be modified to control healthcare costs, he added.
“They become better consumers,” said Denise Davis, Precept’s director of sales. “[Healthcare] is not just a benefit they use without caution or care or thought.”
Precept executives said they have one company signed for the plan. They declined to identify the company other than to say it is a publicly traded technology company based in Orange County.
