Health Net Enters ACO-Like Deal
Health Net, Hill Physicians Group and two major hospital operators in the Bay Area have entered into an ACO-style arrangement to provide care for nearly 6,500 University of California employees and retirees in San Francisco.
The goal of the arrangement, which was announced earlier this week and will be implemented beginning in January, is to prevent any increases in the cost of care for the 6,100 UC employees and 380 non-Medicare retirees during 2013, officials said.
It is the first ACO-like arrangement for the Woodland Hills-based Health Net, which has about 3 million enrollees in California. Hill Physicians and San Francisco-based Dignity Health, one of the hospital operators, have been involved in a similar ACO-like arrangement with Blue Shield of California since 2010.
An accountable care organization involves Medicare enrollees specifically, so its participants have declined to call it such.
Hill Physicians will serve as the primary caregiver for the enrollees. Hospital care will be provided by four San Francisco facilities: UCSF Medical Center and its Benioff Children’s Hospital, St. Mary’s Medical Center and Saint Francis Memorial Medical Center.
“We fully anticipate that this arrangement will foster more frequent communication among all the involved medical providers, which will give patients more support and a better quality of care,” said Glenna Vaskelis, a senior vice president with San Francisco-based Dignity Health, which owns St. Mary’s and Saint Francis. “Ultimately our goal is to improve patient care and satisfaction as a whole.”
No specific targets for improving care will be implemented. Instead, the participants will focus on a variety of measures to cut costs.
“We’re going to be looking at utilization of the emergency rooms, changes in lengths of stay, preventative screenings and coordinate care,” said Health Net spokesperson Brian Justice.
Justice was unable to immediately provide specifics of the payment arrangements, which usually involve the sharing of savings among the entities at the end of the calendar year.
Since it is a risk-sharing arrangement, it will require approval by the California Department of Managed Health Care.
All UC employees and retirees in San Francisco enrolled in a Health Net plan who receive their care via Hill Physicians will be enrolled as part of the arrangement beginning on Jan. 1. It is also being offered during UC’s open enrollment period, which ends on Nov. 20.
