ASO for a provider network selling plan administration services to ERISA (self-insured) employers.

• Administration of Sierra CommCare (the local ERISA provider network) including but not limited to:
  • Maintaining a networked provider panel
  • Contracting with employers and other payors in the community for use of the provider network
  • Seeking to ensure appropriate local control of managed care products
  • Providing medical management and administrative services for the provider network
  • Developing additional health insurance products
• Mental Health/Substance Abuse Clinical Pathway
• Developing community appropriate criteria against which health plans and medical management plans may be assessed
• Community health grant program facilitator and program manager

Cooperative Vehicle:

Sierra CommCare, Inc. (Existing 501(c)(4)) 501(c)(3) application is pending.

Executive Director for SCC is staff for the IWVCHC starting 2/1/00.

SCC and IWVCHC will advise each other and work cooperatively to accomplish shared objectives.

IWVCHC will promote SCC services in the community as a means to better coordinate care; retain local health care dollars; improve quality and access and lower the costs of health care services for the community.

IWVCHC will work with SCC in the development of community appropriate criteria against which health plans and medical management plans may be assessed.

Staffing of the community committee or group responsible for developing a mental health pathway and other health related grant programs will be funded through SCC. IWVCHC has successfully competed for a telemedicine planning grant to develop a telemedicine network for specialty care in the Eastern Sierras. IWVCHC and SCC together sponsored a series of convenings for the California Wellness Foundation’s Future of Work and Health.

SCC has an existing Board of Directors. Four of its thirteen board members have seats on the IWVCHC. Five of SCCs panel of providers also sit on the IWVCHC Council.

One of two multi-specialty physician groups in the community, Ridgecrest Regional Hospital, the Sage Community Clinic, independent physicians, behavioral health providers, tertiary relationships with regional hospitals and medical teaching institutions.

Phase II at an Impasse

Informal assessments of how to assure that the clinical pathways fit feasiblely with DRIS criteria started 5/98 and completed by 3/31/99.

Assuming the successful negotiation of with local physicians to participate in a provider network before 12/31/00, pre-operational planning to start 1/01, however planning is unlikely to be completed before 3/01 when the DRIS Grant Initiative ends. In lieu of providing an administrative function to a local physician network, SCC would still continue as a community health grant program facilitator if it is successful in obtaining 501(c)(3) status.

Possible Phase III Implementation Date: March 31, 2001

© CIRHM