CaliforniaCare Health Plans announces results of program to strengthen hospital network.
The program is designed to develop long-term partnerships with hospitals that demonstrate a commitment to quality, a clear vision of the future and the financial strength to compete in California's market-driven health-coverage environment.
The hospital network recontracting was based on voluntary responses to a Request for Proposal (RFP). Some 370 hospitals, most of which are in the plan's statewide hospital network, participated in the program.
The responses provided information in two basic areas -- 1) data and other statistical information documenting the hospital's commitment to, at a minimum, community standards of quality; and 2) reimbursement rates.
``This program is a viable means of responding to the increasing pressures of the marketplace,'' said Max Brown, senior vice president of network development/management.
``Purchasers and members look to the industry to reduce health- care costs. They also ask the health plans to demonstrate the quality and stability of the provider networks with which they contract.''
Responding hospitals received scores based on the analysis and evaluation of the RFP responses and other quality measures, including clinical outcomes, accreditation from organizations such as the Joint Commission on Accreditation of Healthcare Organizations (JCAHO), and the hospital's managed-care infrastructure.
To equitably compare financial and reimbursement information, hospitals were grouped into six peer categories. This allowed for a comparison of basically similar institutions with regard to size, scope of services and demographic setting.
Almost all of the responding hospitals have been designated as Tier I or Tier II facilities. Some have been listed as pending, including a few large, multihospital organizations with which discussions are continuing.
Tier I facilities are considered long-term BCC partners and will be given preferred status within the CCHP network. These preferred partners may be eligible for a variety of long-term programs such as joint marketing, electronic interfacing, quality and outcome support and simplified utilization management procedures.
Patients admitted to those institutions will be covered by superior hospital benefits, and the institutions will be prominently featured in CCHP promotional material.
Tier II hospitals will continue to participate in the network. However, many patients will be responsible for higher co-payments at those facilities. Members admitted to hospitals identified as pending will not be subject to higher co-payments at this time. Changes in some benefit plans have been made already to reflect higher co-payments at Tier II hospitals.
The tiering designation is not a quality-of-care distinction. The basis of their designation is the relativity of their proposed rates to other hospitals in their peer category, the extent of the change in their proposed rates from their historical rates and the presence of other comparable hospitals in the same service area.
In some cases, hospitals have been designated Tier II because in their areas BCC found a surplus of hospitals with very similar capabilities.
``We feel that our recontracting effort highlights our commitment to develop a hospital network that is more flexible and provides patients with quality health care at the most cost effective prices,'' said Brown.
``This is a rapidly changing, intensely competitive environment in which we need to respond quickly, effectively and efficiently. For that reason, we will use our Partnerships for Quality program to continuously evaluate our hospitals to stay abreast of their performance and ensure our members that they have the most current, accurate data on their providers.''
CaliforniaCare Health Plans is an affiliate of Blue Cross of California. Together with their affiliates, they offer a comprehensive array of managed-care health plans provided through their health-maintenance organization, preferred-provider organization and specialty managed-health-care networks.
Specialty products include pharmacy benefit management, dental, vision, mental health, life insurance, Medicare supplement and workers' compensation. -0-
The following hospitals have been designated as Tier hospitals:
Los Angeles County
Barlow Respiratory Hospital Brotman Medical Center California Medical Center Cedars-Sinai Medical Center Centinela Hospital Medical Center Children's Hospital of Los Angeles Community Hospital of Gardena Daniel Freeman Marina Hospital Daniel Freeman Memorial Hospital Good Samaritan Hospital Kenneth Norris Jr. Cancer Hospital Presbyterian Intercommunity Hospital Queen of the Angels-Hollywood Presbyterian Medical Center Saint Francis Medical Center Saint Vincent Medical Center Santa Monica Hospital Medical Center St. John's Hospital and Health Center St. Joseph Medical Center University of California -- UCLA Medical Center USC University Hospital White Memorial Medical Center Whittier Hospital Medical Center
Northwest Los Angeles
Antelope Valley Hospital Medical Center Henry Mayo Newhall Memorial Hospital
San Fernando Valley
Encino-Tarzana Regional Medical Center (Encino Campus) Encino-Tarzana Regional Medical Center (Tarzana Campus) Medical Center of North Hollywood Northridge Hospital Medical Center -- Roscoe Northridge Hospital Medical Center -- Sherman Way Providence Holy Cross Medical Center Sherman Oaks Hospital & Health Center Valley Presbyterian Hospital Columbia West Hills Regional Medical Center
San Gabriel Valley
Beverly Hospital Casa Colina Hospital for Rehabilitative Medicine Citrus Valley Medical Centers -- Inter Community Citrus Valley Medical Centers -- Queen of the Valley City of Hope National Medical Center Foothill Presbyterian Hospital Garfield Medical Center Glendale Adventist Medical Center Huntington East Valley Hospital Huntington Memorial Hospital Methodist Hospital of Southern California San Dimas Community Hospital San Gabriel Valley Medical Center Santa Teresita Hospital Verdugo Hills Hospital
Avalon Municipal Hospital Lakewood Regional Medical Center Little Company of Mary Hospital Long Beach Community Hospital Long Beach Memorial Medical Center Memorial Hospital of Gardena New Beginnings Lakewood Pioneer Hospital Robert F. Kennedy Medical Center San Pedro Peninsula Hospital St. Mary Medical Center Torrance Memorial Medical Center
Anaheim Memorial Hospital Brea Community Hospital Children's Hospital at Mission Children's Hospital of Orange County Chapman General Hospital Coastal Communities Hospital Friendly Hills Regional Medical Center Fountain Valley Regional Hospital Hoag Memorial Hospital Presbyterian Columbia Huntington Beach Hospital & Medical Center La Palma Intercommunity Hospital Los Alamitos Medical Center Martin Luther Hospital Mission Hospital Regional Medical Center Saddleback Memorial Medical Center Samaritan Medical Center, San Clemente St. Joseph Hospital, Orange St. Jude Medical Center UCI Medical Center -- University of California, Irvine Western Medical Center/Anaheim Western Medical Center/Santa Ana
San Diego County
Alvarado Hospital Medical Center Children's Hospital & Health Center El Centro Regional Medical Center Harbor View Medical Center Paradise Valley Hospital Pioneers Memorial Hospital San Diego Rehabilitation Institute Tri-City Medical Center
San Luis Obispo County
Arroyo Grande Community Hospital French Hospital Medical Center Sierra Vista Regional Medical Center Twin Cities Community Hospital
Santa Barbara County
Goleta Valley Community Hospital Lompoc District Hospital Marian Medical Center Santa Barbara Cottage Hospital Santa Ynez Valley Hospital Inc. St. Francis Medical Center of Santa Barbara Valley Community Hospital
San Bernardino County
Ballard Rehabilitation Hospital Barstow Community Hospital Bear Valley Community Hospital Chino Valley Medical Center Desert Valley Hospital Hi-Desert Medical Center Loma Linda Community Hospital Loma Linda University Medical Center Mountains Community Hospital Needles-Desert Communities Hospital Redlands Community Hospital San Antonio Community Hospital Saint Mary Desert Valley Hospital St. Bernardine Medical Center U.S. FamilyCare Medical Center
Los Robles Regional Medical Center Mercy Healthcare Ventura County -- St. John's Pleasant Valley Hospital Mercy Healthcare Ventura County -- St. John's Regional Medical Center Santa Paula Memorial Hospital Simi Valley Hospital & Health Care Services Ventura County Medical Center
Bakersfield Memorial Hospital Delano Regional Medical Center Healthsouth Bakersfield Rehab Hospital Kern Valley Hospital District Mercy Healthcare Bakersfield Ridgecrest Community Hospital San Joaquin Community Hospital Tehachapi Hospital West Side District Hospital
El Centro Regional Medical Center Pioneers Memorial Hospital
Corona Regional Medical Center Eisenhower Memorial Hospital Hemet Valley Medical Center Inland Valley Regional Medical Center John F. Kennedy Memorial Hospital Menifee Valley Medical Center Moreno Valley Community Hospital Palo Verde Hospital Parkview Community Hospital Medical Center Riverside Community Hospital San Gorgonio Memorial Hospital
Alta Hospital District Central California Rehabilitation Hospital Chowchilla District Memorial Hospital Coalinga Regional Medical Center Corcoran District Hospital Dameron Hospital Doctors Hospital of Manteca Doctors Medical Center of Modesto Emanuel Medical Center Fresno Surgery Center George L. Mee Memorial Hospital Hanford Community Medical Center Hazel Hawkins Memorial Hospital Kaweah Delta District Hospital Lindsay Hospital Medical Center Lodi Memorial Hospital Madera Community Hospital Mammoth Hospital Memorial Hospital of Los Banos Memorial Hospital of Ceres Memorial Hospital/Medical Center Merced Community Medical Center Mercy Hospital and Health Services Natividad Medical Center Northern Inyo Hospital Saint Agnes Medical Center San Joaquin Valley Rehabilitation Hospital Sanger General Hospital Selma District Hospital Sierra Kings District Hospital Southern Inyo Hospital St. Dominic's Hospital St. Joseph's Medical Center of Stockton Tulare District Hospital Valley Children's Hospital Visalia Community Hospital
Alameda Hospital Alexian Bros. Hospital Alta Bates Medical Center Barton Memorial Hospital Biggs-Gridley Memorial Hospital Brookside Hospital Children's Hospital -- Oakland Chinese Hospital Columbia Good Samaritan Hospital of Santa Clara Valley Columbia San Jose Medical Center Columbia South Valley Hospital Colusa Community Hospital Community Hospital Sonoma County Davies Medical Center Doctors Hospital of Pinole Dominican Santa Cruz Hospital Eastern Plumas District Hospital Eden Hospital/Medical Center Enloe Hospital Feather River Hospital Frank R. Howard Memorial Hospital Fremont Medical Center Glenn Medical Center Golden State Rehabilitation Hospital Healdsburg General Hospital Indian Valley Hospital John C. Fremont Hospital John Muir Medical Center Kentfield Rehabilitation Hospital Lassen Community Hospital Laurel Grove Hospital Lucille Salter Packard Children's Hospital Mark Twain Saint Joseph's Hospital Marshall Hospital Mayers Memorial Hospital Mendocino Coast District Hospital Mercy American River Hospital Mercy General Hospital Mercy Hospital of Folsom Mercy Medical Center -- Mount Shasta Mercy Medical Center -- Redding Mercy San Juan Hospital Methodist Hospital of Sacramento Modoc Medical Center Mount Diablo Medical Center North Coast Rehabilitation Center O'Connor Hospital Pacific Coast Hospital Palm Drive Hospital Petaluma Valley Hospital Plumas District Hospital Queen of the Valley Hospital Redbud Community Hospital Redding Specialty Hospital Redwood Memorial Hospital Rideout Memorial Hospital Saint Elizabeth Community Hospital Saint Francis Memorial Hospital Saint Helena Hospital & Health Center Saint Joseph Hospital -- Eureka Saint Louise Hospital Saint Mary's Hospital & Medical Center San Leandro Hospital San Ramon Regional Medical Center Santa Rosa Memorial Hospital Seneca District Hospital Sequoia Hospital Seton Medical Center Seton Medical Center -- Coastside Sierra Nevada Memorial Hospital Sierra Valley District Hospital Siskiyou General Hospital St. Luke's Hospital St. Rose Hospital Sonoma Valley Hospital Sonora Community Hospital Southern Humboldt Community Hospital Stanford University Hospital Summit Medical Center Surprise Valley Community Hospital Tahoe Forest Hospital District Trinity Hospital UC Davis Medical Center UCSF Medical Center UC San Francisco/Mount Zion Ukiah Valley Medical Center Vencor Hospital -- San Leandro Vencor -- Sacramento Watsonville Community Hospital Woodland Memorial Hospital
The following Tier II hospitals represent about 15 percent of the network:
Los Angeles County
Bellflower Medical Center Century City Hospital Coast Plaza Doctors Hospital Community & Mission Hospitals of Huntington Park Hollywood Community Hospital Medical Center Inc. Los Angeles Community Hospital Midway Hospital Monterey Park Hospital Orthopaedic Hospital Pacific Alliance Medical Center Inc. Santa Marta Hospital Suburban Medical Center Washington Medical Center -- L.A.
Northwest Los Angeles
Lancaster Community Hospital
San Fernando Valley
Granada Hills Community Hospital Pacifica Hospital of the Valley Thompson Memorial Medical Center
San Gabriel Valley
Alhambra Hospital Baldwin Park Hospital Covina Valley Community Hospital Doctors Hospital of West Covina Glendale Memorial Hospital and Health Center Greater El Monte Community Hospital Pomona Valley Hospital and Medical Center St. Luke Medical Center
Bay Harbor Hospital Inc. Pacific Hospital of Long Beach South Bay Hospital Woodruff Community Hospital
Anaheim General Hospital Buena Park Medical Center Columbia West Anaheim Medical Center Garden Grove Hospital and Medical Center Irvine Medical Center Placentia Linda Community Hospital Santa Ana Hospital Medical Center/Doctors Hospital of Santa Ana South Coast Medical Center
San Diego County
Continental Rehabilitation Hospital Mission Bay Hospital
Santa Barbara County
Rehabilitation Institute at Santa Barbara
San Bernardino County
Community Hospital of San Bernardino Victor Valley Community Hospital
Community Memorial Hospital of San Buena Ventura Westlake Medical Center
Kern Medical Center
Bloss Memorial District Hospital Central Valley General Hospital Del Puerto Hospital Dos Palos Memorial Hospital Inc. Kingsburg Medical Center
Chico Community Hospital Community Hospital & Rehab Center of Los Gatos Mad River Community Hospital North Bay Medical Center Redding Medical Center Santa Clara Valley Medical Center Tuolumne General Hospital VacaValley Hospital
The following hospitals are still in negotiations:
California Pacific Medical Center -- California California Pacific Medical Center -- Pacific Clovis Community Hospital Community Hospital of Monterey Peninsula Delta Memorial Hospital El Camino Hospital Fallbrook Hospital District Fresno Community Hospital and Medical Center General Hospital Green Hospital of Scripps Clinic Grossmont District Hospital Marin General Hospital Mercy Healthcare San Diego Mills Peninsula Hospital Novato Community Hospital Oak Valley District Hospital Oroville Hospital & Medical Center Palomar Medical Center Peninsula Hospital & Medical Center Pomerado Hospital Recovery Inn of Menlo Park Salinas Valley Memorial Hospital Scripps Memorial Hospital -- Chula Vista Scripps Memorial Hospital -- East County Scripps Memorial Hospital -- Encinitas Scripps Memorial Hospital -- La Jolla Sharp Cabrillo Hospital Sharp Chula Vista Medical Center Sharp Coronado Medical Center Sharp HealthCare Murrieta Sharp Memorial Hospital Sierra Community Hospital Sierra View District Hospital Sutter Amador Hospital Sutter Auburn Faith Hospital Sutter Coast Hospital Sutter Davis Hospital Sutter General Hospital Sutter Lakeside Hospital Sutter Memorial Hospital Sutter Roseville Medical Center Sutter Solano Medical Center Tracy Community Memorial Hospital University of California -- San Diego Medical Center Valley Memorial Hospital ValleyCare Medical Center Washington Hospital
CONTACT: CaliforniaCare Health Plans, Woodland Hills
Elise Anderson, 818/703-2703
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|Date:||Aug 30, 1996|
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