Maybe you’ve seen Monarch HealthCare’s building in Irvine alongside the Santa Ana (I-5) Freeway. It’s the one with the big butterfly on it.
Or maybe you’ve seen one of Monarch’s 1,900 doctors.
With $200 million in yearly revenue, Monarch is among the state’s bigger doctors groups. It’s for the independent-minded physician,Monarch is a loose affiliation for doctors who still own their practices.
“Most people still like to see their independent doctor,” said Dr. Bart Asner, Monarch’s chief executive. “They don’t like to be told what doctor to go to. They like to choose.”
Monarch is an independent practitioner association, where doctors continue to run their own practices but band together for business proposes, including contracting with health plans.
That makes Monarch different than other groups, such as Costa Mesa-based Talbert Medical Group Inc., which employs its own doctors at its nine clinics.
“We are a medical group, but we are not a medical group that employs physicians,” Asner said.
Monarch came about in 1994 through the combination of “fairly small” practice associations that were affiliated with three South County hospitals: Mission Viejo’s Mission Hospital Regional Medical Center, Saddleback Memorial Medical Center in Laguna Hills and South Coast Medical Center in Laguna Beach.
Monarch has gotten buyout offers through the years, including some during the late 1990s heyday of MedPartners Inc., the Birmingham, Ala.-based company that once was the country’s largest operator of doctor groups.
“We said ‘No,'” Asner said.
MedPartners, now Caremark Rx Inc., eventually sold its struggling doctors groups to focus on its mail-order pharmacy business.
Monarch plans to stay independent, according to Asner.
“There is so much that we can do in Orange County to grow and expand,” said Asner, a pediatrician by training.
Monarch handles the finances, legal affairs, insurer payments and human resources for doctors. About 230 people work on that side of the business.
The group uses its size to negotiate contracts with health plans, something Asner said would be challenging for small practices on their own.
“With 1,900 physicians and a very talented, trained negotiating team, we can sit at the same table with those health plans and negotiate a fair and reasonable contract,” he said.
Monarch also looks to keep a lid on costs and boost efficiency, Asner said. That includes using “evidence-based medicine,” which involves applying the scientific method to treat patients.
The group authorizes high-cost services on patients when necessary, “but we make sure they’re not duplicated,” Asner said.
“It’s a big company, a big responsibility, which we take seriously because that money is supposed to go for the care of patients,” he said. “It’s about spending money wisely on patient care.”
Monarch does a lot of what a health insurer does, including handling claims and managing patient care.
“What we really are, in every sense of the word, is a health plan because we take risk, but we’re not actually a health plan that insures the patients or enrolls the patients,” Asner said.
Instead, Monarch patients enroll with a health plan, such as PacifiCare Health Systems, a Cypress-based unit of Minnesota’s UnitedHealth Group Inc. Monarch provides medical treatment under contracts it negotiates with insurers.
Patients can go to 20 hospitals around the county, according to Asner.
“We went throughout the county and built out that infrastructure,the physician network, the hospital network, the ancillary network (radiology and lab),” he said.
Consolidation among health insurers is a concern, Asner said. Monarch contracts with seven health plans today, compared to 16 when it was started 12 years ago.
Take PacifiCare, he said.
“The leadership has moved out of the state of California,” he said. “We’ve lost a lot of the local control of healthcare to four major national players. And they may not understand the California model of healthcare, which is based on medical groups like Monarch working on behalf of independent physicians. In other parts of the country, the health plans contract directly with these physicians and really aren’t used to this delegated model.”
Insurers pay a set amount for treatment under the delegated model, leaving doctors responsible for anything beyond that.
Medical groups and the delegated model, Asner argues, help California have some of the lowest healthcare premiums in the country.
For its part, PacifiCare and UnitedHealth have said they plan to keep delivering treatment to enrollees through doctors’ groups.
