MODESTO -- Doctors Medical Center will receive a $650,000 grant from nonprofit insurer Blue Shield of California to help coordinate care for patients after their release from the hospital.
The Modesto center was one of 18 hospitals and health systems awarded grants from Blue Shield to support "accountable care organizations," a growing trend in health care.
The grants are part of Blue Shield's "2 percent pledge," a promise to cap net income at 2 percent of revenue and return additional income to its customers and the community.
Doctors' accountable care program will seek to improve care for patients discharged from the hospital, so they are less likely to require readmission or emergency room visits. It will target about 7,500 people enrolled in Blue Shield's HMO (or managed care) plans.
Under the federal health care reforms, accountable care organizations are expected to become a model for serving Medicare patients.
Mike King, chief operating officer for Doctors, said the hospital will start the program with Blue Shield subscribers in January, in collaboration with AllCare Independent Physician Association.
A coordination team will follow up with patients to ensure they make appointments with their primary care physicians and have transportation to the doctor's office. Other patients may need in-home risk assessments, monitoring, physical therapy or adult day care services.
"An inpatient setting is very costly and isn't always the optimal setting for patients," King said. "If you can take care of the patients' needs on an outpatient basis, it is better for the patient and it costs less."
Five to seven employees will be hired for the Modesto program, including a director, social worker, vocational nurses and medical assistants, officials said.
Blue Shield fulfilled its pledge in another way, by giving employers that purchase its health insurance a 30 percent credit on their premiums in October, based on profits for 2010. The insurer last week announced a second $295 million giveback based on projected earnings for this year.
Employers who offer Blue Shield coverage for their workers should see a 54 percent credit against one month of premiums in December. The credits for individual policyholders will average $135 for a single person or $420 for a family of four.
"Anything that is going to improve wellness and improve health care in our community is a positive thing," said Nick Bavarro, an employee benefit adviser in Modesto. "These credits from Blue Shield are a great way to help employers during the sluggish economy."
Bee staff writer Ken Carlson can be reached at kcarlson@modbee.com or (209) 578-2321.
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