Administrative Services Organization - Selected 5/29/98

Existing community ASO type administrative and medical management functions to be divested or contracted to a community owned ASO. The ASO is to be an interim step towards building a community owned health plan in HDN.

Divest from the HDN Foundation for Medical Care the following functions:

• Claims Administration
• Billing
• Quality Assurance/Utilization Management (QA/UM)
• Medical Management
• Credentialing
• Member Services
• Provider Services

Other functions which the RHC would like to see provided through the ASO are:

• Referee Services for Mediating and Facilitating Physician and Employer Health Plan Contracting
• Joint Credentialing
• Administration of a Small Employer Purchasing Pool
• Information and Referral
• Community Case Management
• Health Promotion Activities
• Patient Transportation
• Community Pathway for Behavioral Health
• Grant Facilitation, Planning and Coordination for Community-Wide Health Services or System Grants
• Advisory Group on Health Promotion and Health System Issues

Community Health Alliance of Humboldt and Del Norte Counties, Inc. (Newly incorporated 6/00, applying for 501(c)(3) status.)

The ongoing role of the DRIS Regional Health Council (RHC) and Community Health Committees will be to act as a clearinghouse, planning and development task force for the health system, and the health promotion and disease prevention projects in the Humboldt-Del Norte Region. The proposed new corporation governing board is expected to be drawn from the RHC. Remaining members of the RHC will participate on standing committees to the voting board of the corporation in an advisory capacity.

Articles and bylaws approved on April 6, 2000. Board to be selected in Summer of 2000.

The Physician IPA has 97% of the primary care and specialty physicians and mid-levels participating, the County Public Health department, and the six hospitals operating in the two county area.

Phase II

Preliminary Feasibility Analysis done 12/97.

In-Depth Feasibility Analysis started 9/98, completed 6/99

Pre-Operational planning came to an impasse in January 2000 around risk sharing arrangements between physicians and large employers.

Feasibility Analysis of the community operating the Humboldt-Del Norte Foundation for Medical Care underway, to be completed by 10/1/00.

If the business is feasible and the Physician IPA owners of the HDN Foundation for Medical Care are willing to initially lease or eventually sell their business to the community, and the community can afford to take it over, business planning will start 10/00 and finish 1/01. (Business feasibility is predicated on successful negotiation of a shared risk arrangement between the physician network and purchasers.)

If this last step is not workable, the final form the project in HDN will be the RHC operating as a Referral Service Organization (RSO) that also performs grant facilitation and management functions. What this implies is that the RHC will contract for mediation services between employers and providers to facilitate ongoing managed care relationships. The RHC in this form would not meet the DRIS Initiative requirement to be a single accountable entity managing health system decisions and integration in the market. However the RHC would be eligible to apply for a smaller DRIS grant to support an incremental integrated health systems project.

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