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HealthCare Partners: Multi-State Expansion using
FRM
Centricity™ LIVE: May 1, 2015
Orlando, FL
•2
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Individual Page Use?: Yes
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The content of this presentation represents the views of the author and presenters.
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HCP: A History of GrowthLos Angeles Expansion
• Founded in 1992 through the merger of several medical groups in the Los Angeles Metro area
• Acquisitions through 1990’s and early 2000’s concentrated on groups and IPAs in LA County
• Expansion into Orange County, CA, brought first major acquisition with competitive EHR
HCP: From Hillside to Seaside…
HCP: To National Presence
HCP: National Acquisitions - NVFinancial Risk Manager Structure
• IPA and MSO Operations
• Security, operational and reporting separation
• Enrollment structure reflects regional needs
Reg 3 Reg 1-2
Reg 4-7
Reg 3 IPA
All other IPA
NV
HCP: National Acquisitions - AZFinancial Risk Manager Structure
• Focus on IPA Operations
• Decision to build structure single HMO structure for Southwest
HCP: National Acquisitions - FLFinancial Risk Manager Structure
• Focus on Enrollment only
• Challenge in health plan formats and information
HCP: CA Product VariationsNV, FL, AZ
HCP: National AcquisitionsNV, FL, AZ
• New Product Variations
• NV acting as TPA instead of delegated entity
• Varied risk arrangements
• Distinction between plans for enrollment only vs. claims delegation and adjudication
Leveraging Centricity™ Financial Risk Manager (FRM) Platform
Track Attributed and Enrolled Patients
• ACO Attribution
• Enrollment Processing
• Enrollment structure: Capturing PCP, Medical Practice/IPA, Site and Location
Leveraging FRM PlatformBuilding IPA Network Structures
Region VILocation
HCP IPA -Talbert
HCP IPA - AMAEntity
HCP IPA – ARTA
Western MG
IPAsTMG IPA
AMA
TMG IPA -
HCS2000
TMG – IPA
Anaheim
PCP PCPPCPTMG –
IPA Downey
TMG – IPA Long
Bch
TMG – IPA
Orange
TMG – IPA
Tustin
TMG – IPA
Westmstr
PCP PCP PCP
HCP IPA - ARTA
HCP IPA – ARTA Health
Network
Leveraging FRM PlatformReferral and Claims Management
• Finalized Authorizations tracked for adjudication, bed days accruals
• Robust claims engine adjudicates against benefit and contract terms
What’s Next?
Preparing for more growth
• Optum Communications Manager
• Optimization Project
• Percent of Premium Capitation
• Bundled Payment Arrangements