Partnership Health is the provider for the MediCal Managed Care program for 14 counties in Northern California.  As of last year, they had 532,000 lives enrolled. In my community in Sonoma County, we have found the Partnership to be innovative particularly with the care of high risk patients. In addition, they have reimbursed most providers better than the former fee for service MediCal system.

Late last year, I was pleased to hear that the Partnership is in the process of implementing a plan to pay some full time PA/LTC (Post-Acute/Long Term Care) providers 180% of usual rates.  I presume this is based on data suggesting more favorable outcomes at a lesser cost from these clinicians.  I have long thought this to be the case, but haven’t had supporting data.

As a general internist who left his ½ time traditional office based practice in 2005 for a full time PA/LTC practice, I believe I’ve been able to provide more comprehensive and timely care.  Because I don’t have the overhead of an office, I can spend more time on the process of assessing new admission.  In Sonoma County, we have gained access to all the Sutter hospitals EHRs as well as the St. Joseph EHRs.  This means that I can review the hospital record on most of my admissions the same day of admission to the SNF, create a preliminary H&P, and then focus my patient assessment time filling in what I don’t know that will help our team create a comprehensive patient centered care plan.  This was brought home to me this past week, when one of the Social Workers in one of my facilities told me how much she appreciated all the details in my initial assessment.  In facilities with Point Click Care, I can now mine their data base off site for change of condition calls, as well as during subsequent visits.  Office based physicians don’t seem to use this option much yet.  I also have the on-site advantage of knowing the interdisciplinary teams in my facilities which greatly facilitates communication and care planning.  My facilities know that I need to know the discharge dates far enough in advance so that I can see the patient prior to discharge, fine tune the discharge plan, and then dictate a summary that goes to the patient’s community providers.  This hopefully insures successful health outcomes in the months after discharge.

As we move to managing populations of patients, it’s quite helpful to have a 24/7 team of clinicians that support the above level of care.  In my PA/LTC focused on-call group, we are working towards that goal.

I believe that PA/LTC will one day be a medical specialty that rewards clinicians for their expertise and hard work.  I’m glad to see Partnership Health moving us in that direction.  I hope that other MediCal managed care plans in our state and other payers follow their lead.