Maximizing Partnerships in the Changing Healthcare Delivery System

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1 Maximizing Partnerships in the Changing Healthcare Delivery System Erin Westphal, MSG The SCAN Foundation

2 Goals of Session Opportunities for Partnership Affordable Care Act California Duals Integration Potential Partners

3 ACA Opportunities Hospital Readmission Reduction Program National Pilot Program on Payment Bundling Medicare Shared Savings Programs Accountable Care Organizations (ACO) Community-based Care Transitions Program (CCTP)

4 Dual Eligible Demonstrations Green States: $1 Million design grants Maroon States: Test two models for States to better align the financing of the Medicare and Medicaid programs

5 Potential Partners Hospitals Medicare Advantage Plans Special Needs Plans Accountable Care Organizations Major Medical Groups

6

7 Top MA Parent Organizations by Number of California Enrollees Parent Organization Number of California Enrollees Percentage of Total California Enrollees (N = 1,807,489) Kaiser Foundation Health Plan, Inc. 827, % UnitedHealth Group, Inc. 334, % Health Net, Inc. 137, % SCAN Health Plan 114, % WellPoint, Inc. 104, % California Physicians' Service 61, % Aetna Inc. 29, % Easy Choice Health Plan Inc. 27, % Humana Inc. 26, % Care1st Health Plan 22, %

8

9 California Special Needs Plans Alameda Alliance Joint Powers Authority Care 1 st Health Plan CareMore Health Plan Central Health Plan of California, Inc Chinese Community Health Plan Community Health Group Easy Choice Health Plan, Inc Health Net of CA IEHP Health Access Kasier Foundation Health Plan LA Care Health Plan MD Care, Inc Molina Healthcare of CA Orange County Health Authority San Mateo Health Commission Scan Health Plan United Healthcare of California

10 ACOs in California Pioneer ACOs Name City/County Brown and Toland Physicians San Francisco Bay Area Healthcare Partners Medical Group Los Angeles and Orange Counties Heritage California ACO South, Central, Coast California Monarch Healthcare Orange County Primecare Medical Network San Bernardino and Riverside Counties Sharp Healthcare System San Diego County Medicare Shared Savings Program ACOs Name City/County AppleCare Medical ACO, LLC Buena Park, CA Premier ACO Physician Network Lakewood, CA Advanced Payments ACOs Name City/County Golden Life Healthcare LLC Sacramento, CA

11 Major Medical Groups Medical Group Service Area Patients Physicians Income ACO? Health Care Partners Los Angeles and Southern CA 575, docs/3,000 specialists (IPA) Not available Yes: Pioneer Brown & Toland San Francisco 300, docs Operating income $6.8 million Yes: Pioneer Hill Physicians Northern CA 310,000 3,500 docs + specialists Net income $5.4 million Virtual ACO Sharp San Diego Not available Scripps San Diego Not available 2,600 docs Net revenue: $2.1 billion 2,600 docs Revenue: $2.3 billion Yes: Pioneer ACO-like IDN Heritage Provider Network Southern and Central CA 500,000 2,100 docs, 30,000 specialists Not available Yes: Pioneer

12 The SCAN Foundation Initiative

13 Our mission is to advance the development of a sustainable continuum of quality care for seniors. Our vision is a society where seniors receive medical treatment and human services that are integrated in the setting most appropriate to the their needs and with the greatest likelihood of a healthy, independent life. For more information and to subscribe for alerts, please visit us at Follow us on Find us on Facebook The SCAN Foundation

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