Monarch Healthcare: Getting Results
Monarch HealthCare is a medical group owned and operated by independent Orange County physicians dedicated to practicing medicine in a coordinated care setting. Their patients-first, integrated approach works exceptionally well for the 165,000 members of Monarch HealthCare – including 28,000 seniors.
Coordinated care is a fundamental tenet at Monarch HealthCare. Over 2,000 private practice physicians at Monarch believe that the coordinated care model provided through managed care is superior to traditional fee-for-service healthcare because it creates exceptional clinical outcomes and patient experiences by providing the right care with the right people at the right time and the right place.
Some of the innovative hallmarks of coordinated care that Monarch HealthCare has used in pursuit of this goal include:
• A clearly identified “medical home” for all patients, comprised of their personal primary care physician in collaboration with Monarch HealthCare’s comprehensive specialty physician network and care management nurses.
• Performance improvement programs that reward desired outcomes using clinical quality, patient satisfaction, peer review and efficiency metrics.
• Widespread use of Hospitalists, the specialists best qualified to meet patients’ medical needs while in a hospital or skilled nursing facility.
• House calls for homebound patients by physicians, nurse practitioners and social workers.
• And nationally accepted evidence-based clinical guidelines.
It should be noted that programs such as these are typically not available for patients in the fragmented traditional Medicare fee-for-service and PPO models.
Monarch’s Medicare Advantage members enjoy exceptional benefits afforded them by a stable “medical home,” coordinated care, and prevention programs, all designed to improve patient independence and well-being.
As part of the coordinated care model, education and communication is paramount to Monarch’s doctors and nurses.
• They strive to provide the information consumers need to make the right decision about their healthcare.
• They maintain regular communications with their patients through phone, mail, internet and community-based interaction. Patients are contacted on a routine basis to identify chronic health conditions and then coordinate treatment options.
• They provide transportation services, prevention and early detection programs, exercise and healthy living instruction, standard health screenings, peer counseling and healthcare advice.
Based on the experience of over 2,000 physicians and 165,000 patients at Monarch, these coordinated care management programs are proven to work.
Coordinated Care Facts
In 2007, Medicare Advantage saved seniors nearly $90 per month or $1000 per year in out of pocket costs. An estimated savings of approximately $7 billion annually. Additionally, compared to traditional Medicare, Medicare Advantage plans can reduce out-of-pocket costs by up to $4,000 annually for patients with the highest healthcare needs.
- Comprehensive Care: Patients receive integrated treatment plans, and expert case management and disease prevention strategies for the chronically ill.
- Cost-Effective Care: Integrated medical groups are able to support investments in advanced healthcare information technology, tracking patient follow-through on treatment plans and patient outcomes, and helping to uncover health problems before they become catastrophic.
- Accessible Care: Efficiencies within the coordinated care delivery model mean better healthcare for more seniors, including:
• lower out-of-pocket costs
• increased health services such as dental care, vision care and preventive care
• reduced hospitalizations
• increased prescription coverage
• higher overall satisfaction rates
• greater value for the premium dollar than any other healthcare delivery system
What’s At Risk
If Medicare reforms dismantle incentives for coordinated care, seniors will experience significant increases in out of pocket costs - at a time when many seniors have seen their retirement account’s decline by over 40 percent in value — and decreased quality of healthcare.
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