HealthCare Partners Medical Group: safeguarding health throughout greater Los Angeles.

Robert Margolis, MD, CEO of HealthCare Partners, was recently named Chairman-Elect of the National Council on Quality Assurance (NCQA), the first time a physician was so honored. NCQA is a non-profit organization that acts as a watchdog for the managed care industry, with the mission to improve health care quality. Here, Dr. Margolis discusses what employers and employees can do to safeguard health; the need for integrated, coordinated patient care; the impact of pay-for-performance in health care; and the link between good long-term decisions in health and in business.

In a time of difficulty for many health care organizations, HealthCare Partners has remained fiscally stable and has consistently improved its high quality of medical care delivery. What differentiates your medical group leadership?

HealthCare Partners is physician owned and operated. We started with a small group of doctors committed to quality care, and we have continued to grow in size and thrive because we have remained committed as both physicians and managers to patient-centered care. We give coordinated care in a total team environment, with a commitment to continuous, dynamic improvement.

The cost of health care is rising for both employers and employees. What can employees and employers do to improve physical health while guarding their own fiscal stability?

They can look for medical groups that provide systems of very well-coordinated care. Coordinating care creates significant advantages for patients by delivering high-quality care efficiently, so that patients get the most for their health care dollars. When services are integrated and carefully designed across the stream of care, this thoughtfulness up front eliminates duplication of processes and inappropriate services. Both patients and their employers benefit in terms of better health and streamlined costs associated with the care.

At HealthCare Partners, we specialize in providing patient-focused care. We have created strong communications and care delivery systems that extend from the primary care provider to the specialist and to hospitalization when necessary. We know how much care management--special attention to the whole process of giving excellent care and service--can be an important factor in patient outcomes.

The move among many employers today to control the cost of health care premiums by shifting costs to their employees (by increasing the deductibles employees have to pay) and by moving toward low-cost PPO plans is, in my opinion, a move away from quality health care. "Consumer-driven health care" is based on the premise that consumers can make intelligent, informed decisions about what they need. Yet people often do not know much about the state of their own health or about all the options available in accessing medical care for simple or complex conditions. Many times they delay seeking essential care, which can put them at greater risk. The risks are magnified in loose medical networks without coordination of care, because conditions can fall through the cracks or not get timely attention.

That is why at HealthCare Partners, we created Premier Appointments, which can get patients to see their doctors within 24 hours, if necessary. That is why we have Care Teams--clinicians and their assistants focused on patient needs. And why we have a hospitalist program to oversee out patients if they are hospitalized. And it is why we pay so much attention to coordinating and integrating care to fully meet patient needs.

The move away from integrated, managed care may prove more costly over the long run for both employers and employees. A RAND study recently reported that only 54 percent of patients overall are getting recognized protocols of care--the basic standards of medical attention. Too little, too late, and inadequate medical care is a prescription for personal disaster. It can mean the difference between life and death, or additional burdens to loved ones.

Southern California has a slight advantage over other areas of the country in that we have one of the highest concentrations of organized delivery systems, resulting in employer premiums that average 10 percent to 20 percent below the national average.

Many health plans have implemented pay-for-performance incentives for physicians to improve the quality of care they provide. How effective are Pay for Performance programs?

Pay for Performance is a program that works--for the patient, for the health plan, and for doctor groups. California has one of the leading pay-for-performance programs in the nation. A small but important part of pay to physician groups and physicians within these groups is predicated on meeting and continuously improving upon rigorous criteria for the delivery of care. Employers, through their contracts with health plans, now commit significant dollars--$40 to $50 million this year alone--toward providing incentives to physician organizations to measure, monitor, and report publicly the quality of medical care delivery. Physician organizations that can't measure and monitor quality delivery lose. The key has been standardized metrics for quality and patient satisfaction that are recognized by all major health plans.

At HealthCare Partners we have been in the vanguard advocating for quality patient care. Over the decades, we've won numerous awards for leadership and quality care delivery. We always have ranked at or near the top in patient satisfaction scores and in our pay-for-performance measures. In the past year, we made significant investments to ensure that our performance and the structures to continuously improve and support quality health care delivery are in place.

What specific investments have you made?

We recently invested in an electronic health record system upgrade that will connect all our physicians and clinicians over the entire continuum of care. This system will give us real-time connectivity to foster operational efficiencies. From the medical standpoint, it also will improve patient safety, reduce practice variation and incorporate best-evidence medical care processes into daily practice. It will bring measurable value to physicians and patients.

The new clinical information system will also better support our innovative "Patient Flow" system, another major investment we have made. Patient Flow controls the way our patients are treated in the primary care doctors' offices. Patient Flow includes our Premier Appointments scheduling system 2mentioned above. It also includes automatic referral authorizations for the most common specialty services, new patient orientations sessions, and Care Teams for primary care patients. Patient Flow is a set of policies and procedures that has helped us make each patient encounter as pleasant as possible; it is our effort to create patient-friendly environments throughout our organization.

Additionally, we have management programs to monitor hospital stays and care delivery, and chronic disease management programs so that patients can get the best evidence-based medical protocols appropriate to their conditions.

Can you put some numbers to these investments in improvements?

Our investment in new technology is valued at between $8 million$10 million. The amount invested in our people--physicians and staff--to educate and help them to take best advantage of these systems is easily twice that. And there is a reason for that: Technology is a crucial tool for improving the flow of care, diagnostic precision, and efficiency of services, but it is our people--their judgment, their expertise, their experience, and their human touch--that gives meaning to health care.

Health care is a very complex business. At HealthCare Partners, we've always taken pride in our company culture. To take root, innovation requires effective execution.

What do you see as the future of health care?

Physician groups will continue to take the lead in defining what makes good medicine. This is important, because doctors dedicate their lives to understanding and improving health. Organizations such as the Committee on Accountable Physician Practices (CAPP) disseminate information about innovations that make sense in terms of health management as well as good business practices.

Pay for Performance is putting increased emphasis on organized, coordinated care systems, and this trend toward whole-systems thinking and quality improvement will continue to evolve. It will help patients to live fuller lives and will help doctors, nurses, and other professionals to perform in peak ways.

The technology that makes monitoring and data collection in clinical systems possible is in place and growing more sophisticated. The melding of refined back-end systems with increasingly informed patients and compassionate coordinated care delivery processes will extend patients lives, improve quality of life, and reduce morbidity.

HealthCare Partners strives to be ahead of that expectation curve, with sensible and life-enhancing programs that help patients and the employers who bear most of the cost. The pace of change in health care has accelerated. And we can all be beneficiaries of that change.

HealthCare Partners Medical Group and its affiliated independent physician associations (IPAs) serve over 500,000 managed care and fee-for-service patients. The medical group provides services through approximately 400 physicians at 32 neighborhood offices and four urgent care centers throughout greater Los Angeles. It is the second largest medical group in California. For more information about HealthCare Partners and its programs (including occupational health services), or to discover how HealthCare Partners can support employee health programs, call the Communications/Marketing Department at [phone] or visit www.healthcarepartners.com. The Right Doctor Can Make All the Difference.