How do providers with no patient risk-bearing experience prepare for their transition from volume to value?
The experience of one independent practice association (IPA) in Southern California, AppleCare Medical Group, offers some valuable insight.
Since it went into business in 1996, AppleCare has been bearing patient risk. Co-founders Vinod Jivrajka, MD—who goes by Dr. Vinod—and Surendra Jain, MD have built
AppleCare into a successful IPA, managing the care of about 100,000 HMO members. Members have access to approximately 450 primary care physicians in 300 different locations in the two counties. Vinod and Jain say certain principles they follow have both ensured their success and could help other organizations better manage patient risk.
The first principle is to be sophisticated about managing risk. When AppleCare landed its first contract in 1996, Vinod and Jain weren’t choosy about the terms—they were thankful for the business. Now, however, they thoroughly scrutinize the contract terms. Financial analysts run the contracts through financial and clinical risk models so the doctors understand the opportunities and risks involved.
Once AppleCare takes on patient risk, they have a sophisticated care management infrastructure that helps the organization promote appropriate utilization in both inpatient and outpatient settings. Their care management program includes a team of full-time hospitalists, nurse case managers, social workers, pharmacists, and medical directors. This team manages patient referrals for care as well as on-site evaluation of patients in their primary hospital facilities and comprehensive care clinics.
In our next blog, we’ll look at the next guiding principle that has helped AppleCare successfully manage risk: taking good care of its physicians.
To learn more about how AppleCare successfully manages risk, download the case study.