7/31/2019 Payers & Providers California Edition Issue of August 9, 2012

1/6

'/./,)'$-'!(&!'"'!(&!'*#'+#57,'?'+7>+ H| }hjj oi

uyojh~ail hk |ai Ngjiklgr ~in|h`k*~ugni uirch||hkm+

Ngjhd`rkhg Ilh|h`k

\ai iqugk~h`k `d Cilhnghl hk |ai n`chkmxigr~ n`yjl ur`ti g o``k |` |ai o`||`c jhki~`d ]``ljgkl Ahjj~#og~il hk~yrir Aigj|a Ki|gkl J`km Oigna#og~il C`jhkg Aigj|angri+

Oy| d`r |ai c`cik|* |ai u`r|h`k `d |ai dilirgjur`mrgc |ag| ur`thli~ aigj|a n`tirgmi |` |aiijlirjx gkl lh~gojil u`uyjg|h`k~ h~ g lrgm `k|ai igrkhkm~ `d o`|a aigj|a ujgk~+

Gj|a`yma Aigj|a Ki| ricghkil ur`|goji*h| h~ ~|rymmjhkm }h|a n`~| h~~yi~ ~yrr`yklhkm h|~Cilh#Ngj ~ikh`r~ gkl uir~`k~ }h|a lh~gohjh|hi~!^UL( u`uyjg|h`k* g~ }ijj g~ ~`ci d h|~ jgrmimr`yu n`ccirnhgj gnn`yk|~+ G~ g ri~yj|* h|~ ki|hkn`ci d`r |ai ~in`kl wygr|ir iklhkm Fyki >5iqnjylhkm g `ki#|hci g~~i| ~gji lr`uuil c`ri|agk 85)+

Cigk}ahji* C`jhkg u`~|il g ~hmkhngk|j`~~ d`r |ai ~gci |hci uirh`l* gj~` lyi |` ^UL

~|rymmji~+Gj|`mi|air* C`jhkg u`~|il g ki| j`~~ `d,>=+> chjjh`k `k ritikyi~ `d ,7+9> ohjjh`k+\ag| n`cugri~ |` ki| hkn`ci `d ,7=+< chjjh`k`k ritikyi~ `d ,7+7> ohjjh`k d`r |ai ~in`klwygr|ir `d ?577+

N`cugkx `dnhgj~ ojgci |ai j`~~ k~uhrgjhkm n`~|~ hk \iqg~* `ki `d h|~ ki}i~|cgrbi|~ }airi h| h~ ur`thlhkm Cilhnghlcgkgmil ngri ~irthni~+ H| h~ nyrrik|jx j`~hkm,7< chjjh`k g c`k|a `k h|~ `uirg|h`k~ hk |aiJ`ki ^|gr ^|g|i+

Gnn`rlhkm |` C`jhkg* |ai cilhngj j`~~

rg|h` }g~ 758+7)-'D8498'M5==,G'A15'H>/)1578'

2=90>789'84'H8'F95.>'E1L)57,'B9=='.)157')>'49E/,,''2J,'84'>)157'E>,)C,7N)9>8

^UL N`~|~ L`m C`jhkg* Aigj|a Ki|Ahmair#\agk#Ur`fin|il Iquik~i~ ^|yk| Igrkhkm~

A1974''88/=';549E=';8.5N58)'98';549E75''4/*=5)755':9=)>8-'H8'F95.>G'''49,E/,,9>8'>0'85^)'.5857)9>8'N549E='N8.5N58)')E)9E,G'

K$$UCK&-W$UG

2=9E_':575'0>7';>75'D80>7N)9>8

Gymy~| 7>#79

^iu|icoir 8#77

M5,)578'2=9N'2>805758E5G'I589,,8E5'\,N575=4'I5,>7)-'+=N'HL798.,G'Y5B'

45LN58),'98'*9==98.'84'=5.='9,,/5,'98')15'E=9N,'75=NG'2>,)'Y'G

2=9E_':575'0>7';>75'D80>7N)9>8

]IOHKG_ ]ilki~lgx* Gymy~| 79* ?57? 75 G+C+* UL\

NGJHD@_KHG AIGJ\A OIKIDH\ IQNAGKMI6 G U_@M_I^^ _IU@_Ujig~i f`hk Lgthl Ugky~a* lhrin|`r `d m`tirkcik| rijg|h`k~* |ai Ngjhd`rkhg Aigj|a Oikidh|~Iqnagkmi* Gk|a`kx ]rhma|* iqiny|hti lhrin|`r* Aigj|a Gnni~~* gkl F`k Mgoij* ~ikh`r dijj`}*K@_N/Ykhtir~h|x `d Nahngm`* |` lh~ny~~ |ai kiq| cgf`r ~|iu hk |ai hcujicik|g|h`k `d |ai Gdd`rlgNgri Gn| hk Ngjhd`rkhg+

a||u6//}}}+aigj|a}io~ycch|+n`c/uu51797?+a|c

g Aigj|angri]io^ycch| Itik| n`#~u`k~`ril ox UGXI_^ $ U_@THLI_

N`k|hkyil `k Kiq| Ugmi

http://www.hfma-cafallconf.org/http://www.hfma-cafallconf.org/http://www.hfma-cafallconf.org/http://www.hfma-cafallconf.org/http://www.hfma-cafallconf.org/http://www.hfma-cafallconf.org/http://www.hfma-cafallconf.org/http://www.hfma-cafallconf.org/http://www.hfma-cafallconf.org/http://www.opalevents.org/p/73/3rd-annual-medical-management-in-medicare-advantage-payerprovider-collaborative-care-summithttp://www.opalevents.org/p/73/3rd-annual-medical-management-in-medicare-advantage-payerprovider-collaborative-care-summithttp://www.opalevents.org/p/73/3rd-annual-medical-management-in-medicare-advantage-payerprovider-collaborative-care-summithttp://www.opalevents.org/p/73/3rd-annual-medical-management-in-medicare-advantage-payerprovider-collaborative-care-summithttp://www.opalevents.org/p/73/3rd-annual-medical-management-in-medicare-advantage-payerprovider-collaborative-care-summithttp://www.opalevents.org/p/73/3rd-annual-medical-management-in-medicare-advantage-payerprovider-collaborative-care-summithttp://www.opalevents.org/p/73/3rd-annual-medical-management-in-medicare-advantage-payerprovider-collaborative-care-summithttp://www.opalevents.org/p/73/3rd-annual-medical-management-in-medicare-advantage-payerprovider-collaborative-care-summithttp://www.opalevents.org/p/73/3rd-annual-medical-management-in-medicare-advantage-payerprovider-collaborative-care-summithttp://www.westernclaimconference.com/http://www.westernclaimconference.com/http://www.westernclaimconference.com/http://www.westernclaimconference.com/http://www.westernclaimconference.com/http://www.westernclaimconference.com/http://www.westernclaimconference.com/http://www.westernclaimconference.com/http://www.westernclaimconference.com/http://www.healthwebsummit.com/pp081512.htmhttp://www.healthwebsummit.com/pp081512.htmhttp://www.hfma-cafallconf.org/http://www.westernclaimconference.com/http://www.opalevents.org/p/73/3rd-annual-medical-management-in-medicare-advantage-payerprovider-collaborative-care-summit

7/31/2019 Payers & Providers California Edition Issue of August 9, 2012

2/6

'/./,)'$-'!(&!'"'!(&!'*#'+#57,'?'+7>95 a`~uh|gj~ hk gjj+ H|d`ny~il urhcgrhjx `k |ai ?5? a`~uh|gj~

Ugxir~ $ Ur`thlir~ Ugmi ?

\`u Ujgnicik|+++O`||`cji~~ U`|ik|hgj

Gltir|h~i Airi

!1==( ?45* iq|+ ?

Hk Orhid

Ij Ngchk` Lh~|rhn| Mi|~Ahma Cgrb~ Hk Gylh|

Gk `y|~hli gylh| `dIj Ngchk`A`~uh|gj Lh~|rhn| hk C`yk|ghk Thi}

ag~ n`knjylil |ai lh~|rhn| h~ y~hkm h|~|gq ritikyi~ guur`urhg|ijx+

Gnn`rlhkm |` |ai gylh|*n`klyn|il ox BUCM `k oiagjd d |aiJ`ngj Gmiknx D`rcg|h`k N`cch~~h`k`d ^gk|g Njgrg N`yk|x* |ai lh~|rhn| agltirx j`} `tiraigl iquik~i~~uinhngjjx oingy~i Ij Ngchk`A`~uh|gj uird`rc~ gkx glchkh~|rg|hti|g~b~+ \ai lh~|rhn| rinihti~ ,74chjjh`k hk gkkygj |gq ritikyi~*~in`kl kjx |` |ai ,?=+4 chjjh`krinihtil ox |ai Ugj`cgr Aigj|aLh~|rhn| hk ^gk Lhim` N`yk|x+

BUCM gj~` n`knjylil |ag| |ain`ccykh|x oiki|~ ur`thlil ox IjNgchk` |` ug|hik|~ gkl |ai

~yrr`yklhkm rimh`k |`|gjil 8+9) `d|ai a`~uh|gj~ `tirgjj `uirg|hkmiquik~i~ |ai ~in`kl ahmai~| `dn`cugrgoji a`~uh|gj lh~|rhn|~ hkNgjhd`rkhg+ @d |ai ,9

KI]^

CII\ X@Y_ DIJJ@] _IGLI_^

Kiil |` ur`c`|i g n`kdirikni0 X`yr orgkl0 Ugxir~ $Ur`thlir'~i#cghj jh~| d`r gjj ilh|h`k~ h~ gtghjgoji d`r x`yrcgrbi|hkm kiil~+ _igna `y| |` c`ri |agk 7?*555aigj|angri ur`di~~h`kgj~ }a` rigl `yr uyojhng|h`k~+ NgjNjghri \agxir g| !1==( ?45* iq|+ > `r i#cghj air g|njghri|Ecn`j+n`c+

Gj|`mi|air* |ai ujgk u`~|il ki| hkn`ci `d,7?

7/31/2019 Payers & Providers California Edition Issue of August 9, 2012

3/6

'/./,)'$-'!(&!'"'!(&!'*#'+#57,'?'+7>Ugxir~ $ Ur`thlir~

J`kmir GJ@^'&

Gltir|h~i Airi

!1==( ?45* iq|+ ?

&D`r yr gl~* k`| x`yr a`~uh|gj

Hk Orhid

ri~hlik|~*/ ~ghl F`ak V`mjhk* naghrcgk`d |ai lh~|rhn|~ o`grl `d lhrin|`r~+ G~g uyojhnjx gnn`yk|goji rmgkhvg|h`k*}i gri n`cch||il |` gn|hkm hk |aic`~| |rgk~ugrik| cgkkir gkl klhkm}gx~ |` oi||ir hkd`rc* ilyng|i gkl~irti |ai n`ccykh|x+ ]i }hjjn`k|hkyi |` n`jjgo`rg|i nj`~ijx }h|a

JGDN` gkl }hjj ur`thli `km`hkmyulg|i~ |` n`ccykh|x go`y| |ai ~|iu~}i gri |gbhkm |` cgbi dyr|airhcur`ticik|~+

Bgh~ir ^gx~ Y~i @dUir~`kgj Aigj|a

_in`rl~ Ox Ikr`jjii~N`k|hkyi \` Mr`}

@gbjgkl#og~il Bgh~ir Uircgkik|iag~ riu`r|il |ag| < chjjh`k `d h|~ikr`jjii~ gri k`} y~hkm Cx Aigj|aCgkgmir* h|~ uir~`kgj aigj|a rin`rl go`y| 4>) `d gjj ijhmhoji y~ir~+

\` lg|i* Bgh~ir ikr`jjii~ agtiy~il |ai ~x~|ic |` thi} kigrjx >5chjjh`k jgo`rg|`rx |i~|~ `kjhki2ridhjjil 75 chjjh`k uagrcgniy|hngjuri~nrhu|h`k~2 gkl ~nailyjil ?+=chjjh`k guu`hk|cik|~+

/Cx Aigj|a Cgkgmiricu`}ir~ cicoir~ |` |gbi nagrmi`d |aihr aigj|a* gkl `yr lg|g ~a`}|ag| |aix gri l`hkm fy~| |ag|*/ ~ghlBgh~ir Nahid Iqiny|hti @ddhnirMi`rmi Agjt`r~`k+ Ai gllil |ag||}` |ahrl~ `d UA_ y~ir~ agtij`mmil `k|` |ai ~x~|ic g| jig~||}hni+ ]i bk`} |ag| n`kkin|hkmug|hik|~ |` |aihr l`n|`r~ gkl aigj|ahkd`rcg|h`k gkl |``j~ hcur`ti~wygjh|x `y|n`ci~* ug|hik|~g|h~dgn|h`k gkl ug|hik|icu`}ircik|+

\ai UA_ }g~ gj~` cgligtghjgoji |ar`yma c`ohji ua`kiguujhng|h`k~ hk Fgkygrx+ H| ag~riu`r|il c`ri |agk ?>9*555l`}kj`gl~ `d |ai guujhng|h`k|ar`yma |ai hUa`ki gkl Gklr`hlujg|d`rc~ |` lg|i+ Jg~| c`k|a*go`y| 74) `d gjj th~h|~ |` |ai Bgh~ir}io~h|i k`| |ai UA_ }iri thg~cgr|ua`ki~+

KI]^

^\@_HI^ @D @KI AHMAJX JH\HMH@Y^ UAX^HNHGK

,754a`yr~ g cyj|huji `d c`ri |agk d`yrn`cugril |` |ai `|air a`~uh|gj~+

@yr klhkm~ ~a`} g dyklgcik|gjch~cg|na hk ~yuujx gkl licgkl `dicirmiknx ~irthni~* ~ghl _ikii X+ A~hg*C+L+* g~~h~|gk| ur`di~~`r `d icirmiknxcilhnhki g| YN^D gkl |ai ~|ylx~ jigl gy|a`r+

Gnn`rlhkm |` A~hg* ~yna g lhddirikni hklhtir~h`k ~|g|h~|hn~ uy|~ chk`rh|x icirmiknxr``c ug|hik|~ oihkm |rgk~u`r|il ox gcoyjgknig| g cyna mrig|ir rh~b d`r g n`cu`yklhkm `d|aihr aigj|a ur`ojic~ n`cugril |` |aihr }ah|in`yk|irugr|~+

Hd x`y ug~~ ox g nj`~ir a`~uh|gj |ag| h~ `lhtir~h`k d`r g a`~uh|gj 79 chky|i~ l`}k |air`gl* x`y gri hknrig~hkm |ai gc`yk| `d |hci

|ai ug|hik| h~ hk g n`cur`ch~il ~h|yg|h`k* ~~ghl+ H| uy|~ |ai~i ug|hik|~ g| ahmair rh~b d`rogl aigj|a `y|n`ci~ dr`c n`klh|h`k~ jhbiaigr| g||gnb~ `r ~|r`bi* }airi chky|i~ n`yjlcigk |ai lhddirikni oi|}iik jhdi gkl lig|a+

Kg|h`kgj lg|g gjriglx n`knjyli |ag|chk`rh|x mr`yu~ ~yna g~ Jg|hk`~ gkl GdrhngkGcirhngk~ gri c`ri jhbijx |` lhi `d ~|r`bi~ `aigr| g||gnb~ n`cugril |` }ah|i~+ \ai ~|ylxn`yjl k`| ~gx hd gcoyjgkni lhtir~h`k~ ujgxig ~hmkhngk| dgn|`r hk |a`~i lhddirikni~+\ai ~|ylx }g~ uyojh~ail hk |ai c`~| rinik|h~~yi `d |ai f`yrkgj Aigj|a Gddghr~+

https://www.managedcarestore.com/pandp/p&pphysicianwp.htmhttps://www.managedcarestore.com/pandp/p&pphysicianwp.htm

7/31/2019 Payers & Providers California Edition Issue of August 9, 2012

4/6

'/./,)'$-'!(&!'"'!(&!'*#'+#57,'?'+7>=/35';-'0,,/5'E(+#57,'?'+7>'&('

,/*,L79*57,AN'0)'9,'45=989L'85J,=5))57N'=='4==#J>>4']#-'Q/9)5'XX/7*8M-'2''$&V(V

]5*,9)5

JJJNG#57,84G7>3

BL5*>>M

JJJN_L5*>>MNL>3RG#57,G7>3RG#57,G7>79='X>74Q)5/G[>,,'S>=4*57.-'033549)5'+,)'+75,9458)-'6>,'[>*=5,'T>,G9)='

84'\549L='258)57\7M'B98/L85-'\8.98.'F975L)>7-''=8#']79.1)-'Zo5L/)93

2>8)79*/)98.'Z49)>7g)1#'\9==57'g5==5#

0_'#>/'4>'8>)'75L598'

O1/7,4#-'G=5,5'L=='D@UUA!;@H!EW(N

K`} |ag| |ai Y+^+ ^yurici N`yr| ag~linhlil |ag| @ogcgNgri~ cgklg|i |` oyxaigj|a hk~yrgkni h~ g |gq* }hjj |ai Hk|irkgj_itikyi ^irthni oi goji |` n`jjin| h|0Mikirgjjx ~uigbhkm* hd x`y `}i |ai H_^* h|}hjj mi| |ai c`kix dr`c x`y}h|a |aiu`~~hoji iqniu|h`k `d |ai @ogcgNgri |gq+\a`yma @ogcgNgri~ hklhthlygj cgklg|ihcu`~i~ g |gq `k ui`uji }a` l` k`|uyrnag~i m`tirkcik|#guur`til aigj|ahk~yrgkni* |ai jg} iqujhnh|jx kiy|ir~ |ai H_^~gohjh|x |` n`jjin| |ai |gq+

Ohvgrri0 Xi~+ Gkl h| cg||ir~+ Hdu`jhnxcgbir~ iquin| ykhk~yril x`ykm ui`uji

|` oyx aigj|a hk~yrgkni }aik h| h~ itik c`riiquik~hti |agk h| h~ |`lgx* |ai |arig| `d~irh`y~ n`k~iwyikni~ d`r k`| l`hkm ~` cy~|oi rigj+ Xi~* |ai |arig| |ag| |ai H_^chma| n`ci gd|ir x`y hd x`y l` k`| l`}ag| x`y gri |`jl j``b~ rigj g| r~|mjgkni+ Oy| Lic`nrg|hn u`jh|hnhgk~*digrhkm uyojhn ognbjg~a d`r cgbhkm |aicgklg|i |`` hk|ry~hti* uyjjil h|~ |ii|a+

Dhr~|* |ai |gq/uikgj|x h~ |`` ~cgjj|` cg||ir |` |ai ui`uji }a` gri h|~|grmi|+ Hk ?57) d |aihrhkn`ci~ d`r urichyc~ gkl yu |` 4) `d |ain`~| `d |ai hk~yrgkni hk lilyn|hoji~ gkl n`#ugxcik|~+ \ag| gll~ yu |` g j`| c`ri |agk 89oynb~+

^in`kl* |ai jg} n`yk|~ `k c`~| `d |ai~n`dg}~ |yrkhkm |aic~ijti~ hk+ Hd x`y l` k`|agti hk~yrgkni gkl |ahkb x`y `}i |ai |gq*|aik x`y }hjj oi g~bil |` nainb g o`q |` |ag|

iddin| `k x`yr |gq ri|yrk+ Hd x`y na``~i |`hmk`ri |ai cgklg|i* x`y chma| gj~` na``~ik`| |` nainb |ai o`q+ Oy| itik |a`~i }a` l`n`kdi~~ |ag| |aix l` k`| agti hk~yrgkni cgxk`| oi jhgoji d`r |ai ki} |gq+ Hjjimgj gjhik~*Kg|hti Gcirhngk~* urh~`kir~* |a`~i }a` gri}h|a`y| hk~yrgkni d`r ji~~ |agk > c`k|a~*|a`~i }a` l` k`| agti |` ji gk hkn`ci |gqri|yrk* gkx`ki }a` dgni~ g agrl~ahu `rngkk`| kl gdd`rlgoji n`tirgmi* gkl `|air~gri gjj iqicu|+

\ahrl* |ai jg} riwyhri~ |ai H_^ |` ~hd|

|ar`yma 7 `k |a`y~gkl~ `d ki}

}`rbir~ gkl yumrgli~ |` n`cuy|i~x~|ic~+Dhkgjjx* itik hd |ai H_^ ag~li|irchkil |ag| x`y `}i |ai ki}|gq* h| ag~ tirx jhch|il gohjh|x |`d`rni x y |` ugx h|+ Og~hngjjx* |aiH_^ ag~ |}` `u|h`k~6 \` g~b x`y d`|ai c`kix gkl |` rilyni |ai ~hvi x`yr |gq ridykl+ Oy| |ai H_^ ngkk`

rilyni x`yr ridykl ykji~~ x`y `tirugx+ ^hkni|gqugxir~ agti mrig| n`k|r`j `tir |aihr

}h|aa`jlhkm* g ~gttx |gqugxir }a` l`i~ k`|}gk| |` oyx hk~yrgkni n`yjl ig~hjx }`rb |ai~x~|ic |` ik~yri |ag| |ai H_^ n`yjl k`| a`jlognb ah~ ridykl |` ikd`rni |ai cgklg|i |gq+Gkl agjd `d Gcirhngk a`y~ia`jl~ l` k`| `}igkx hkn`ci |gq |` oimhk }h|a* ~` m``l jynbmi||hkm |ai c`kix dr`c |aic+ Gkl agjd `dGcirhngk a`y~ia`jl~ l` k`| `}i gkx hkn`c|gq |` oimhk }h|a* ~` m``l jynb mi||hkm |aic`kix dr`c |aic+

\ah~ n`k|rg~|~ ~agrujx }h|a |ai }gx |ai H_n`jjin|~ `|air |gqi~+ \` uy| h| ~hcujx* |ai H_^mi|~ |ai c`kix h| h~ `}il oingy~i h| ag~ or`gu`}ir~ |` ikd`rni n`cujhgkni+ Gd|ir gjj* |air

g rig~`k }iri gjj ~ngril `d |ai H_^+

Ox

F`~iua Gk|`~

gkl Chnagij _+

^|rghk

@u#il ~yoch~~h`k~ `d yu |` 455 }`rl~ gri

}ijn`cil+ Ujig~i i#cghj ur`u`~gj~ |`

ilh|`rEugxir~gklur`thlir~+n`c

7/31/2019 Payers & Providers California Edition Issue of August 9, 2012

5/6

7/31/2019 Payers & Providers California Edition Issue of August 9, 2012

6/6

Ugxir~ $ Ur`thlir~ CG_BI\UJGNI/ICUJ@XCIK\ Ugmi 4

^IIBHKM G KI] U@^H\H@K0

NGK AIJU+

]i uyojh~a gltir|h~icik|~ d`r |a`~i ~iibhkmki} ngriir

`uu`r|ykh|hi~ d`r fy~| ,7+?9 g }`rl+

Hd x`y uridir lh~nri|h`k* }ijj agklji gjjri~u`k~i~ |` x`yr gl+

Ngjj !1==( ?45* iq|+ ?* `r i#cghjgltir|h~iEugxir~gklur`thlir~+n`c+

H| n`~|~ yu |` ,?=*555 |` dhjj g aigj|angri f`o&

}hjj l` h| d`r g j`| ji~~+

Icuj`xcik| jh~|hkm~ oimhk g| fy~| ,7+49 g }`rl

Ngjj !1==( ?45* iq|+ ?@r i#cghj6 gltir|h~iEugxir~gklur`thlir~+n`c

@r th~h|6 }}}+ugxir~gklur`thlir~+n`c

&Ki} Ikmjgkl F`yrkgj `d Cilhnhki* ?55