53.2 F
Laguna Hills
Thursday, Mar 28, 2024
-Advertisement-

MemorialCare, Anthem Create Reform-Age Network

Orange County’s hospital market is continuing its move toward networks and partnering in the age of healthcare reform.

Fountain Valley-based MemorialCare Health System is the latest pillar in the trend, announcing last month that it would be the exclusive local provider for Anthem Blue Cross Vivity, an integrated healthcare network bringing together insurer Anthem Blue Cross and seven hospitals and health systems in Southern California to serve larger businesses.

Large Client

Vivity already has a large client, the California Public Employees Retirement System, which is the country’s second largest purchaser of health benefits.

CalPERS said it was going to use Vivity network doctors and hospitals in its Select HMO network in Orange and Los Angeles counties.

Vivity’s coverage will start Jan. 1.

The network is different from the 2012 combination of St. Joseph Health and Hoag Memorial Hospital known as St. Joseph Hoag Health in that it involves a direct relationship with an insurer a la Kaiser Permanente, which is considered a pioneer in the “integrated care” movement.

“We are not in the ‘insurance business’ with this product, per se,” said Barry Arbuckle, MemorialCare’s president and chief executive.

Vivity “runs through Anthem Blue Cross. The founding partners have jointly capitalized Vivity and are sharing risk as a single entity,” he said.

Vivity has an exclusive provider relationship with Memorial- Care’s hospitals, ambulatory care sites, and doctors’ groups, including MemorialCare Medical Group and Greater Newport Physicians.

It will have a reach into hospitals that generally don’t come to mind in the big three alliances.

“Through the recently announced partnership between MemorialCare and [University of California-Irvine], UC Irvine Health will also be available for members,” Arbuckle said, adding that Vivity will also be part of MemorialCare’s 2015 health benefits offering for its workers and their families.

Arbuckle noted that it was “a very collaborative process from the beginning” between Anthem Blue Cross, a unit of Indianapolis-based WellPoint Inc., and its partner health systems.

Kaiser said the trend doesn’t faze it.

“I’m not surprised. I’m pleased with it—our community needs it,” said Julie Miller-Phipps, senior vice president and executive director for Kaiser Permanente Orange County.

Kaiser operates the county’s largest HMO, with 480,000 members, along with hospitals in Anaheim and Irvine and about 900 doctors throughout OC in the Permanente Medical Group.

“The [accountable care organizations] and partnerships are definitely gunning for us,” Miller-Phipps said. “It is all good. The overall health of the community improves.”

Kaiser has operated in a “business as usual” mode in the wake of other alliances, she said.

“I don’t really expect [our] basic healthcare delivery to change” with the emergence of Vivity and St. Joseph Hoag Health.

Miller-Phipps did say that Vivity and other alliances may lead to Kaiser looking at “things we take for granted” when it comes to marketing and awareness.

She noted that, regardless of the Vivity alliance, integrated care in the reform era requires an adjustment in how business is done, and said providers will have to adapt to how insurance payments are changing to emphasize quality and patient outcome rather than just being paid per procedure without regard to either.

Costs

Miller-Phipps said she expects costs to start dropping for hospitals and providers. Industry watchers say reform will cause providers to adjust because lower payments will force them to be more judicious about ordering tests and other services.

Dr. Richard Afable, St. Joseph Hoag Health’s chief executive, said his organization’s partners came together in 2012 to create a delivery system “that better meets the needs of people, companies and the community in general.”

Afable said, however, that healthcare reform isn’t the sole driving force in network creation.

“Many of us were looking at creating networks of care before the Affordable Care Act,” he said, because they sensed integration benefited community health.

St. Joseph, CHOC

St. Joseph Hoag found another partner in August, when it announced it was forming an accountable care organization with the 279-bed Children’s Hospital of Orange County in Orange.

CHOC and St. Joseph Hoag are sharing in the financial and medical responsibilities of providing and managing pediatric patients’ care. The institutions said they came together for several reasons, including “[creating] efficiencies through collectively attending to patients’ needs and avoiding unnecessary treatments.”

CHOC remains independent and will continue to care for children outside of the accountable care organization.

Hospitals that aren’t part of the larger cells are also getting in on the alliance game.

UC Irvine Medical Center, a 411-bed teaching hospital in Orange, linked with MemorialCare last year, and the pair is opening primary healthcare clinics throughout Orange and Los Angeles counties. The partnership is expected to receive an influx of newly insured patients from healthcare reform.

Memorial Care and UC Irvine Health, UC Irvine Medical Center’s parent, are also offering a stroke care program.

Want more from the best local business newspaper in the country?

Sign-up for our FREE Daily eNews update to get the latest Orange County news delivered right to your inbox!

-Advertisement-

Featured Articles

-Advertisement-
-Advertisement-
-Advertisement-
-Advertisement-

Related Articles

-Advertisement-
-Advertisement-