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Working in Diverse Markets, a Healthcare Company Achieves Noteworthy Population Health Results

April 21, 2017
by Mark Hagland
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Alignment Healthcare’s senior executives share their perspectives on population health management progress

The Orange, California-based Alignment Healthcare, which describes itself as “a population health management company focused on improving care delivery, one patient at a time,” is a complex, multi-faceted healthcare organization with very different books of business in different healthcare markets in the three states in which it operates—California, North Carolina and Florida. Not surprisingly, that results in complicated explanations of what it does. But whether it is operating as a health plan or a provider of care management or other services, Alignment Healthcare is making serious progress in some key areas around population health—and that is worth noting.

Altogether, the organization serves more than 50,000 people in California, North Carolina, and Florida—with 32,000 of those individuals in California, 9,000 in North Carolina, and 8,000 in Florida—and is growing at 60 percent per year.

The organization uses a statement that summarizes what its people do, and how they do it: “We lead with a proven, replicable and scalable clinical model that improves quality while decreasing costs. We are a one-stop-shop, able to bring health providers (physicians and hospitals) and payers (health plans) onto one team to improve the health and wellbeing of Medicare beneficiaries at a lower cost,” the statement says.

And, in that regard, Alignment Healthcare executives note the following gains they’ve made in the markets in which they operate. Among them:

>  In California, seniors have seen 50 percent fewer hospital admissions in 2015 than before they enrolled in Alignment Healthcare’s home-monitoring program.

>  In North Carolina, the 30-day re-admission rate for patients enrolled in the organization’s home-monitoring program for all of 2015 was zero—compared to a national Medicare average readmission rate of about 18 percent. This is especially meaningful because these patients are the sickest of the sick.

>  In Florida, Alignment Health has achieved a 43-percent lower hospital inpatient admission rate than the Medicare fee-for-service market average.

>  Also in Florida, it has achieved a 54-percent lower hospital readmission rate than the Medicare fee-for-service market average.

>  In California, it has lowered the ED visit rate by 38 percent, among plan members enrolled in its home-monitoring program.

>  In California, plan members enrolled in the organization’s hypertension management program have seen an 8-percent drop in systolic blood pressure.

>  In North Carolina, enrollees in the organization’s diabetes management program have seen a 20-percent drop in hemoglobin a1c values.

As to how Alignment Healthcare operates, in California, it is a health plan that manages the care of more than 32,000 covered lives in California. In North Carolina and Florida, it is a risk-bearing entity that takes financial risk and management responsibilities from health insurers and manages defined populations under contract.

Recently, Arta Bakshandeh, D.O., the senior medical officer, and Kerry Matsumoto, the CIO, of Alignment Healthcare, spoke with Healthcare Informatics Editor-in-Chief Mark Hagland about the progress that they and their colleagues are making in managing defined populations through data analytics-driven care management programs. Below are excerpts from that interview.

Alignment Healthcare is a rather complex organization, isn’t it? Can you summarize how you work in the different markets in which you operate?

Arta Bakshandeh, D.O.: In California, we are a health plan, and we hold a Knox-Keene license with CMS [the federal Centers for Medicare and Medicaid Services] and hold 35,000 covered lives, where we’re the payer. In Florida and North Carolina, we’re the risk-bearing medical services organization, and we take the financial risk and management from a payer.

Is there an easy phrase that encompasses that?

Bakshandeh: Population health describes what we do. We are managing a Medicare population in almost every realm that you would manage Medicare—Medicare Advantage, as a health plan; as a partnership; under fee-for-service; and also as a delegated medical services organization. We also deliver services, when we’re not the risk-bearing entity, and contract with a health plan or health system, and help them or teach them to deliver care in Medicare Advantage, using our analytics, and we get a PMPM [per-member per-month capitated payment] and a gainshare. At the end of the day, our mission is to improve care one patient at a time, whether we’re the plan, the risk-bearing entity, or services organization.

So the term ‘population health management company’ is a term that correctly encompasses what you do?

Bakshandeh: Yes, that’s correct.

You’re in how many metro markets or regions?

Bakshandeh: Alignment Healthcare is the parent company, based in Orange. From there, we operate in three states—California, North Carolina, and Florida. We’re the health plan in California, where we’re called Alignment Health Plan, based in Orange, with more than 32,000 covered lives—in Medicare Advantage. In North Carolina, we’re called Alignment Healthcare of North Carolina, with multiple health plan partners, including Humana and FirstCarolinaCare, in Wake County. And services are in six counties, with a risk model in county. In California, we operate as Alignment Health Plan. In Florida and North Carolina, we partner with insurers and plans, and provide services under the name of Alignment Healthcare. Alignment also partners with hospitals, physician groups, and health systems, and provides services under the name of Alignment Healthcare.

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