Founded in 1993, Partnership HealthPlan of California is committed to helping the members and communities it serves to be healthy. A public/private entity that is a division of the state of California, the organization provides cost-effective healthcare delivery to Medi-Cal recipients in a number of California counties.

“We always felt that we have to live up to the partnership principle and be sure that our programs work for providers and members,” CEO Jack Horn says. “We believe we have to run a tight ship – our administrative cost is 3.5 percent, among the lowest in state. We put about 94 cents of every dollar back to healthcare.”

Meeting a Need

The organization got its start in Solano County, but it since has expanded several times. It moved into Napa County in 1998, Yolo County in 2001, Sonoma County in 2009 and Marin and Mendocino counties in 2011. The organization is currently serving 201,487 members and continues to grow. In fact, it will expand into Lake County later this year.

About half of the organization’s membership is age 18 and under. Single mothers and their children make up a large part of its population. Other major parts of its member portfolio include the disabled population and people in need of long-term care.

Partnership HealthPlan of California is focused on improving access, quality and cost-effectiveness of care through a managed care system. It works to connect each of its members with a primary care provider, reduce unnecessary trips to the ER, provide the right level of inpatient care, develop innovative case management programs and provide more services locally.

Not all of its services have been tailored to Medi-Cal recipients, and Partnership HealthPlan of California has been involved with several other community healthcare programs. From 2002 to 2005, it served 5,200 members enrolled in the Solano County CMSP program. Also in 2005, the organization was licensed by the California Department of Managed Health Care (DMHC) to offer a Healthy Kids program.

In 2007, it began PartnershipAdvantage – a Medicare Advantage special needs plan for members with Medi-Cal and Medicare in Solano, Napa, and Yolo counties – through a contract with the federal government. In 2010, the DMHC licensed the group to offer a Healthy Families plan in Solano, Napa, Yolo and Sonoma counties.

“The biggest factor for our growth has been geographic expansion,” Horn says. “Another thing that has helped is that we’ve establishing a reputation for service and collaboration. Our board includes representatives from our communities, consumers and providers: We work closely with physicians in our physician advisory group, and we reach out to consumers to help us make decisions.”

An important part of staying connected to consumers is the organization’s consumer advisory committee, and it also conducts regular consumer surveys and focus groups. These outreach efforts give the organization a better understanding of its members’ needs to determine how it can improve services.

Growth Spurt

With healthcare reform on the horizon, Partnership HealthPlan of California expects to grow by about 30 percent because of the coming changes to the system.  The organization already has experience with California’s Healthy Families and Healthy Kids programs, which will be wrapped into Medi-Cal.

To help prepare for growth, Partnership HealthPlan of California has been focused on building infrastructure. It is involved in a major data warehouse project and is upgrading to the next version of its claims processing system.

“We are also going through a management analysis of our key staff, using a consultant to approach that from an outside view,” Horn says. “That will help us determine how we may have to change the organizational structure. In addition, we added an operation excellence department that is working on lean principles, purchased and moved into a new building last November and worked with a consultant to help us expand telecommuting. Those are all moves related to growth preparation.”

Other changes that could be on the horizon focus on care coordination. The organization is exploring several different  models to determine the most efficient way to coordinate care. Another area of interest is telehealth and devising innovative ways to pay those specialists.

“We’ve also added home visits and put in a transition-of-care program to address and avoid re-hospitalization,” Horn says.

Having already demonstrated an ability to absorb growth as it has doubled in size during the last three years, Partnership HealthPlan of California plans to focus on smart growth and not overextending itself. “There is still a lot of uncertainty about reform, so we have to be nimble and not add resources until we are sure that programs are clearly going to happen,” Horn says.

Ultimately, Horn says the organization recognizes that it is in a service business and has to take care of the needs of members, providers and employees. “We can’t provide good service if we have dissatisfied employees, and that is why we put a lot of effort into having the right management team and motivating our people,” Horn says. “Our people are what allows us to make sure that quality of care and successful outcomes are our top priorities.”

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