Friday, December 18, 2015 12:00 AM

Partnering to care for rural, under-served communities

The Valley’s leader in clinic care and the region’s leader in specialized, critical care are partnering to create a new managed-care network for central San Joaquin Valley’s underserved. The joint venture between Adventist Health-Central Valley Network and Community Medical Centers improves access to higher-level care for Medi-Cal patients in rural areas, and it helps expand access to primary care closer to where patients live in Fresno, Kings, Madera and Tulare counties.

“The collaborative venture will deliver more comprehensive, efficient, lower-cost and high-quality healthcare to a population in need,” said Tim Joslin, CEO of Community Medical Centers.  “Clearly we’re building on the strengths of both organizations.”
 

Adventist Health and Community have similar healthcare missions and philosophies, and complementary strengths to better manage the health of entire families and communities. Adventist Health’s Central Valley Network has an extensive system of clinics, specialty outpatient facilities and rural healthcare expertise, while Community provides the region’s highest level of acute, inpatient services, including the only burn and Level 1 trauma center between the Bay Area and Los Angeles. This new partnership between Community and Adventist Health could eventually relieve pressure on local emergency rooms and provide better follow-up care after hospitalizations for Medi-Cal patients who live in small, rural communities, helping to reduce healthcare costs for all.

Since the Affordable Care Act’s passage, tens of thousands of Valley residents have enrolled in Medi-Cal, joining the nearly one in three Californians who now receive the state-supported health insurance coverage. But while more people now have access to medical insurance, they don’t necessarily have access to doctors. The Valley has one of the lowest doctor-to-patient ratios in California and Medi-Cal has one of the lowest physician reimbursement rates in the nation.

Studies show when patients cannot find a regular doctor or get a timely doctor’s appointment, they rely on hospital emergency care, already significantly crowded in the Valley. And when patients come to crowded ERs for non-emergency care it drives the cost of healthcare up. The goal of Community and Adventist Health’s new network is to get patients treated earlier, closer to home to avoid those expensive ER visits.

“Adventist and Community are collaborating to better organize and deliver care, cooperate on processes, and share data to improve the health of this population,” said Aldo De La Torre, Community’s senior vice president of managed care and strategic alliances. This type of collaboration is common in today’s  healthcare industry and consistent with the goals of the federal Affordable Care Act.  By more effectively managing the care for health populations – improving access to services and helping patients be healthier – the goal is to lower overall healthcare costs.

Subject to approval by the California Department of Managed Health Care, Adventist Health and Community will build upon the managed Medi-Cal Adventist Health Plan that begins in Kings County on January 1. The two will remain independent organizations, but the joint-venture health plan will be equally financed, jointly owned and operated collaboratively. Within the next two years, it’s estimated the new plan could deliver coordinated, clinically integrated care to as many as 200,000 people in four counties.


Erin Kennedy reported this story. She can be reached at MedWatchToday@communitymedical.org