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The Continuing Evolution of an IPA: Hill Physicians Medical Group Steve McDermott December 2, Managed Care Online - HealthWebSummit
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2. 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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4. 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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6. 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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8. Administrative Expense Trends
Increasing Trends
Decreasing Trends
2000
2001
2002
(Projected)
Information Services
Health Services
Network Support
All
Other
Financial Services
Customer Services
Claims Payment

9. Customer Satisfaction
Members 90% 
Practice Managers 85% 
Physicians 76% 
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10. 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 hasn’t changed either.
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