No Magic Bullet, Just a Strong Foundation: A California Payer-Provider Breakthrough

When it comes to payer-provider collaboration, no region of the country has been bursting with more activity than the state of California; it is very clear that both provider leaders in medical groups and health systems, and health plan leaders, really are on the same page these days in working collaboratively to improve the health status and the care management of at-risk patients/plan members.

Per that, this spring, I wrote about the groundbreaking partnership  between California’s Health Net on the payer side, and Dignity Health and Vivant Health on the provider side, a collaboration that has averted unnecessary hospital inpatient days, freeing up crucial resources for emergency room care and leading to a substantial enhancement in valued-based care coordination for higher-risk Medicaid members. That collaboration has averted more than 400 unnecessary inpatient hospital days, freeing up critical emergency room resources; increased by 20 percent the patients who received a primary care physician or specialist follow-up appointment post-discharge; and averted potentially $1.7 million in costs.

This spring, I interviewed Anshul Dixit, M.D., supervisory medical director at Health Net, regarding how the program was developed, and its results so far. As Dr. Dixit told me then, regarding some of the clinical and operational cultural changes needed to break through to innovation, “With respect to the culture, these teams have created an atmosphere in which all points of view are respected and considered. The clinical piece is part of it, but there’s a social work piece and behavioral health piece, and connections to ambulatory care. So we’ve been able to give staff across the spectrum an important voice in the members’ care plan; that’s resulted in averting unnecessary hospital stays, improved care transitions; it’s a shifting of the care paradigm, so to speak.”

And I spoke very recently with Dr. Dixit and with Keith Andrews, M.D., chief medical officer at Vivant Health, the independent practice association (IPA) involved with Health Net and Dignity Health in this exciting initiative. As Dr. Andrews told me about the success of the initiative, “There’s no magic bullet; there’s no one thing we did that made a huge difference. It was a million small things. The hospital, IPA, health plan, leaders all came together. The health plan delegates the case management reviews to us at Vivant. And we developed a transition of care model to get the patients, and getting everyone in the room, we were able to develop a plan for each patient.”

Further, Dr. Andrews noted, “Every patient is unique. It’s like rounds: the key is to get the decision-makers in a room at the same time. We work with social workers from the hospital and various ECM [enhanced care management] programs.”

Per all this, Dr. Dixit emphasized that “The stars aligned in 2022, early 2023. And we believed the MediCal population was not served well within the current biomedical paradigm of care, that they had SDOH [social determinants of health] needs that were not being addressed—substance use disorders, unhoused, etc., needed better support. To focus on outcomes as well as costs.

Among the key advances in all this, Dr. Dixit noted, have been that “Communication has gotten much faster; communication loops have been closed promptly and swiftly. Also, all care team members have an equal voice: social works, nurses, physicians, ECM folks, all have been equally involved in the care plan.”

This honestly is precisely the kind of initiative that I wish all of our audience members could learn more about. Well, the exciting thing is that people can hear Drs. Andrews and Dixit share about this important initiative on July 23 in San Diego, during our Healthcare Innovation San Diego Summit, being held at the Hyatt Regency La Jolla. Those two distinguished physician leaders will share the stage with me in a panel discussion on what they’ve accomplished, the challenges they’ve overcome, and the lessons learned so far in that important initiative. Won’t you join us? You can register here.

In the meantime, I can say very honestly that learning about exciting payer-provider collaborations like this one, and interviewing their leaders, is one of the most exciting satisfying things I do here at the publication. Being able to share the successes of such pioneers speaks to the core of our mission here at Healthcare Innovation, and it is immensely rewarding to be able to share these stories with our readers. Kudos to the leaders of these initiatives, and we continue to find it deeply satisfying to share their stories.