You have to really read this press release very carefully as we all know that United Healthcare bought the Memorial Care IPA last year and now it appears Memorial Care Foundation IPA has purchased the management company that runs Greater Newport Physicians. When it came out in the news, the subsidiary of United, Optum was the name of where it fit in the organization. 
OptumHealth (Subsidiary of United Healthcare) Takes Over Memorial IPA in California-Subsidiary Watch
So if you follow the trail of who owns who, well guess what we come right back to United Healthcare in control of yet another IPA physicians group. If you read the story below about the ACO with Hoag Hospital and Blue Shield working together with the Greater Newport Physician’s group, we have United Healthcare thrown in here too as they, via MemorialCare IPA run this group of doctors with also having purchased the group Nautilus that manages Greater Newport Physicians. What a mess.
Health Insurance Contracts at the OC Corral–Lawsuits, an ACO and A Lot of Mixed Up and Confused Patients As Data Disruption and Patient Care Move Center Stage…
Meanwhile over at the other Newport and Orange County HMO, Monarch, also owned by United Healthcare we have this and a lawsuit filed by Blue Shield. The legal suit says patients were encouraged to change plans to keep their current doctors.
United Healthcare Acquisition of Monarch Healthcare HMO Already Causing Confusion and Access Problems for Blue Shield Patients in Orange County
You can read below what the Nautilus service that Memorial purchased says and see who else is on the list for clients, Cedars-Sinai Health Group for one and this is right off their website. Ok so via a subsidiary acquisition here, this puts United subsidiaries in several places to manage, contract and what ever else they come up with for MD reimbursement, procedures, etc. In addition the quote below also shows an EMR NextGen listed as their “preferred solution”. This is kind of interesting since Cedar Sinai is mentioned and they are an Epic EHR group and Untied is busy working with Epic to integrate their newly created clearinghouse subsidiary. How close is this division of United getting or is going to move in the direction of more MDs let’s say at Cedars for an example.
OptumInsight (A Wholly Owned Subsidiary of United HealthCare Optum Division) Creates Medical Clearinghouse Integrated With Epic Practice Management Software-Subsidiary Watch
From the Nautilus website:
“We employ approximately 350 people in areas including: administration, finance, information services, clinical, customer service, and operations. Currently, we contract with over 500 physicians in Huntington Beach, Fountain Valley, Newport Beach, Irvine, Costa Mesa, and Aliso Viejo. Our physician groups are top ranked in California on clinical measures and patient satisfaction. Our groups are leaders in EMR adoption and our Physician Services Division has a growing client base for the Nautilus/NextGen EMR solution.”
My question is how is this ACO going to work with Hoag Hospital and Blue Shield and what will be the outcome of their lawsuit against Monarch and now that I have read this, again with subsidiary ownership by Untied, how complicated will this get and gee will the Greater Newport Physician’s Group be pulled into the lawsuit in time as well since they are now in the United Healthcare subsidiary daisy chain?
Remember they bought the company that runs GNP under the Memorial umbrella Foundation IPA which is owned by Untied. Will patients face the same frustration once this second IPA begins new potential business models? 
Doctors of course I’m sure will want to know what’s in the next reimbursement talks and who’s standards for the ACO will be in place, Blue Shield or United or both? Will we have yet even more issues with getting things set up with conflicting or different policies and goals for doctors to meet from each end? This appears to be a big rats nest and brings about a good question at the link below…how many subsidiaries of one insurance conglomerate can solicit and gain contract without some conflict of interest when so many subsidiaries are involved. One company is looking to have a bit too much power in my opinion. BD
Subsidiary Watch-Corporate Conglomerate Insurers Reduce Compensation Contracts Using One Subsidiary Then Market Same MDs With Another Subsidiary in Health IT
Attack of the Killer Algorithms–Digest & Links for All Chapters–See How the Math and Crafty Formulas Today Running on Servers 24/7 Make Life Impacting Decisions About You
400 Primary & Specialty Physicians Serving 100,000 Re
sidents Join MemorialCare Medical Foundation, Creating New Division Offering More Physician Alignment Options; Nautilus to Lead MemorialCare IPA, Practice Management Services
Orange County, CA—MemorialCare Health System announced today the affiliation of Greater Newport Physicians with its MemorialCare Medical Foundation and the acquisition of Nautilus Healthcare Management Group, Greater Newport’s affiliated management services organization.
Greater Newport Physicians, created by a group of physicians in 1985 to improve health care for the community, serves more than 100,000 Orange County residents through its 400 physicians, comprised of 140 in primary care and more than 250 representing over 50 specialties. With 400 plus employees, Nautilus Healthcare Management offers services to physician groups, Independent Practice Associations (IPAs) and physician offices.
http://www.memorialcare.org/medical-group/news-press-release.cfm?id=133
No comments:
Post a Comment