Mark Costa
Senior Vice President & Area Manager
Kaiser Permanente
Orange County Southern California
Kaiser Permanente remains unique, in that as an integrated health system, all components of the health-delivery system, including the insurance component, are working as one and with one purpose. This is important because it allows all members of the care team to reference a patient’s health history, to fully understand their care path. It leads to a decrease in ordering unnecessary or repetitive tests while ensuring the highest quality, cost-effective care. It’s all built around prevention and long-term care.
These relationships are essential. No one entity can have the necessary impact on the health of an individual receiving service. By working together in formal partnerships, care coordination can be improved.
Maintaining our focus on the overall health of each member we serve is essential. The cost of healthcare continues to be of high priority to all. We know that the incidence of chronic disease, as well as mental illness, are two major contributors to growing costs. By identifying better ways to support individuals in maintaining healthier lifestyles and their mental wellness, further success can be achieved in reducing the cost of healthcare while improving health outcomes.
The health plan marketplace in California is different in a number of ways compared to other states. It’s very competitive and has a much larger percentage of insured individuals covered through HMOs and other managed-care plans, including Medicare patients who more often look to Medicare Advantage plans for their personal coverage. All in all, the competitive California market has led to a broader selection of health plan options focused on quality and affordability. Overall membership growth for Kaiser Permanente in the Orange County market has been very positive during the past five years. Low unemployment rates, as well as past Medi-Cal expansion programs, led to more insured individuals.
The focus is always on the health of the member/patient and how to fully utilize technology, health information and the skills of physicians and other caregivers to attain the highest quality care at an affordable cost. Telemedicine, member education, and proactive identification of poor health habits are programs that can make a difference. The use of health data is also essential in addressing health needs. When these partnerships are fragmented, the use of data cannot be fully optimized and can be costly. We will stay committed to our integrated system of care during these potential times of change in our national healthcare policies and programs.
Robert Falkenberg
Chief Executive
UnitedHealthcare
We are committed to the value-based care arrangement, and we really believe that the future of delivering care more affordably is through our network of accountable care organizations. UnitedHealthcare works in a value-based relationship with 110,000 physicians, 1,100 hospitals, 800 accountable care organizations and 15 million members nationwide. These relationships account for more than $52 billion payments this year, a number we expect will increase to $65 billion by next year.
We are increasing our support for accountable care organizations because we know they succeed. ACOs perform better than non-ACOs on 83% of the most common quality measures we monitor. [The Centers for Medicare & Medicaid Services established the Medicare Shared Savings Program for ACOs on January 2012. The voluntary program is designed as an umbrella entity that allows doctors and hospitals to contract with health insurers to better coordinate care for Medicare patients.]
ACOs have demonstrated that they deliver quality and efficient care, resulting in better health outcomes and lower costs. Those that work with UnitedHealthcare have achieved 11% fewer hospital admissions, 8% fewer emergency room visits, and 9% shorter in-patient length of stay. We serve 27 hospitals in Orange County.
UnitedHealthcare’s accountable-care approach is unique because we offer a variety of value-based programs so we can customize payment models with care providers and meet them where they are in terms of readiness to move from fee-for-service to value-based contracts.
We have more than 110,000 employees, 3,900 in the state.
The accountable care organization is part of NexusACO, the first national health plan built on the foundation of ACOs. UnitedHealthcare developed NexusACO in response to national employers’ desire for an ACO-based health plan that they could offer to employees located anywhere across the country. Nexus ACO [which was launched in November], is now active in Los Angeles and Orange counties, where we are partnering with HealthCare Partners in El Segundo and Monarch HealthCare in Irvine.
The HealthCare Partners and Monarch HealthCare ACOs are not mergers with UnitedHealthcare; rather it’s a formal relationship we have established with those providers. We are working together to manage all aspects of health for a specific patient population.
Eugene Rapisardi
President and General Manager
Cigna
Southern California and Nevada
There’s always a good relationship between [health] plans and actual providers. But what the Affordable Care Act did was get people to think about healthcare differently. What is happening now is beyond just a good relationship—true collaboration. We have a real example in Orange County. We’ve partnered with St. Joseph Hoag Health in a new joint venture to offer Orange County employers HMO health plans branded as St. Joseph Hoag Select, and exclusive provider organization plans branded as St. Joseph Hoag Flex. The joint venture was announced in October 2015, officially launched in January 2016 and this year expanded to San Diego with Scripps Health and Los Angeles with HealthCare Partners (see related story, page 14).
Healthcare, while being a national and global issue, is really a local issue. Orange County is very diverse if you look at the coastal areas versus Santa Ana, versus Garden Grove, versus South County—those are very different areas with very different needs. The good thing about working collaboratively with St. Joseph Hoag Health is that each [of its seven] hospitals has a localized solution for each market—St. Joseph Orange will engage [patients] differently from Hoag Hospital Newport Beach, which is different from Mission Hospital in Mission Viejo.
This is a very unique hybrid risk arrangement in which all are equal partners, participating and sharing incentives for improving quality and outcomes. Nobody takes more burden than the other. We are in each other’s space a little more but in a good way. Before, it’s a win-lose situation where the insurer decides how much and what to pay to a provider, and now with the new structure, it’s a win-win for providers, health plans and physician groups.
We bring what we do best and collaborate. We went through weeks and weeks of understanding each of our capabilities, where those capabilities duplicate, and who would be better at which responsibility. We’ve got partners all around the country, and what we do best is selling products so we take on that responsibility. St Joseph Hoag is great at the nurse-and-patient model, and we delegate that service to them.
The collaboration also allows us to work hand in hand, incorporating data St. Joseph Hoag collected into our analytic reporting tool.
The other carriers are all looking to launch their own version of a product that looks something like this one. But this is not a typical accountable care organization product. This is a more intensive collaborative arrangement—a more intensified joint venture.
The regulatory environment will not change this whole importance of wellness. Everybody, including lawmakers, understands the importance of living a healthier lifestyle, patient engagement, and disease prevention. That discussion will continue to go on.
