The Continuing Evolution of an IPA: Hill Physicians Medical Group Steve McDermott December 2, 2002 Managed Care Online - HealthWebSummit

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The Continuing Evolution of an IPAHill
Physicians Medical GroupSteve
McDermottDecember 2, 2002Managed Care Online -
HealthWebSummit
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Hill Physicians Medical Group

• 340,000 HMO Members
• 2,000 Physicians and 20 Affiliated Hospitals
• Largest Capitated Medical Group in CA
• Largest IPA in U.S.
• Top Performing Medical Group (PBGH)
• Among Top Ten Elite Medical Groups in U.S.

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Goals for 2002

• 1. Enrollment Growth/Geographic Expansion
• 2. Clinically Oriented/Performance-Driven
  Culture
• 3. Continued Development of Information
  Technology
• Infrastructure
• 4. Strengthen Delivery System Management
• 5. Improve Administrative Efficiencies

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Ongoing Long Term Initiatives

• 1. Group Practice Development
• 2. Health Services Development
• 3. E-Connectivity/Information Systems

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Recent Innovations

• Clinical Snapshots Notifications/Prompts to
  PCPs
• Group Visits Asthma, Diabetes, Migraines, Back
  Pain
• PCP Pay for Performance 6M in 2002 10 of
  Comp.
• Referral/Auth Re-engineering Simplify Process
• Practice Support Programs Emphasis on Managers

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Anticipate Managing Populations (as well as
patients)

• Tie physicians together clinically and
  financially through accountable medical
  organizations.
• Standardize acute medical services, manage
  chronic care conditions, and create more
  proactive health-care orientation.
• Compensation balance capitation (population
  management) and fee-for-service (individual
  patient care) against performance/results.

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Next Steps

• Integration through Practice Consolidation /
  Electronic Connectivity/Culture
• Expand Clinical Support Programs, Particularly
  for Chronic Disease
• Electronic Clinical Information System

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Administrative Expense Trends
Increasing Trends
Decreasing Trends
2000
2001
2002 (Projected)
Information Services
Health Services
Customer Services
Financial Services
Claims Payment
Network Support
All Other
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Customer Satisfaction

• Members 90 ?
• Practice Managers 85 ?
• Physicians 76 ?

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Three California Experiments
1. Delegated model health plans capitate
medical groups who, in turn, manage the care
and the resources for 8 million people. 2.
Integrated Healthcare Association open
collaboration among all health care stakeholders
to address common issues. 3. Pay for
Performance adopt common statewide medical
group report card and tie significant financial
incentives to results.
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Medicare

• 900 LB. GORILLA
• Fee-for-Service Medicare continues to be the
  primary driver of American medicine.
• CPT codes pay for time and cost no codes for
  quality, performance, or outcome promotes
  quantity rather than quality.
• Day-to-day practice of medicine has not changed
  in thirty years not coincidentally, payment
  methodology hasnt changed either.