Dr. Richard Merkin has spent the last 30 years perfecting solutions and a successful workable business model to address the needs and challenges of affordable, managed, accountable patient doctor centric health care. Not only has he been a visionary in this field, but he has a proven track worthy of duplicating nation wide to help solve the top health care issues currently facing our country.
Operating as an integrated health care system, Dr. Merkin is President and CEO of Heritage Provider Network, that develops, organizes, and manages both medical groups and independent practice associations. One of the key ways Heritage sets itself apart is by facilitating the collaborations between these groups and other care providers, like hospitals and ancillary care organizations to form truly integrated health care systems. Based in Marina del Rey, California, the company also assists health care service plan employees with physician, hospital and health care services.
Established in California in 1979, the health group began when current President and CEO Dr. Richard Merkin was working in emergency care. “When we began, I was director of an emergency department in California and one of my old professors became a director with Blue Cross and at the time Blue Cross was having difficulty with maintaining quality and fiscal integrity in its managed care in southern California. I was asked if I would develop a medical group and take on the global risk of hospital and professional services for that community and this became what we call today an accountable care organization.”
Bringing People Together for the Patient
Currently the group has expanded its services to cover both southern and central California and New York state. Overall there are now 30 group models and Heritage has contracts with about 2,000 primary care providers, approximately 3,000 specialists and around 150 hospitals. Merkin says that what sets Heritage apart the most is its approach to caring for the whole person, and that philosophy goes beyond just the physical ailment, to social issues involved in care as well. “We try to create cross departments and reach out and collaborate with all the constituents that interact with a patient to create a positive experience throughout the whole process, from the waiting room to filing claims.”
A Multifunctional Role Offers Dramatic Benefits
The utilization of hospitalists has been an important feature in Heritage’s approach. Although the health group has been utilizing the services of these coordinating physicians since the groups inception, today hospitalists are very common. Merkin says this helps alleviate many problems typically encountered with hospital care. “There used to be quite a discrepancy with the way physicians organized their schedule. Some would come in early others while other would follow up on tests late in the evening. It was determined that if we had someone in the hospital all the time they could order tests, evaluate them and stay with the patient to make services more efficient and also help the primary care physician.” In fact, Merkin says, the use of hospitalists has improved re-admission and average length of stay rates while eliminating wasted resources.
Caring for Patients Before It’s Critical
“We’re trying to continue to improve the patient experience. We are making a point to emphasize pre-hospital care, by doing things like establishing high risk clinics that allow us to become aware of the complexity of a patient’s needs over the continuum of care,” explains Merkin. Thus, patients that need to be more closely monitored can have physicians come to their home and patients that have complex disease states can visit high risk clinics, resulting in patients being seem much more frequently, but for much less critical or costly care. With programs like discharge follow-up, coronary artery disease care management and cardiology clinics, the focus is on managing care and preventing emergency services.
A Force for Medical Activism
Part of the collaborative philosophy transfers into community activism and support of medical research. “We try to encourage all of our partners to reach out and become active in the communities though non-profit and volunteer endeavors.” Heritage offers its own help to groups, from an organization which attempts to accelerate the process of finding cures to the establishment of a stem cell research foundation at both Harvard and MIT. Additionally, Heritage has established a chair position at Cal Tech and a fellowship in International Medicine at the University of Southern California.
Although collaboration is a big part of Heritage’s philosophy, sometimes it also can be one of the group’s biggest challenges. “We are taking highly individualized physicians, nurses, scientists and asking them to work together. It can be difficult, but once people realize what they are working for, they begin to work better together. We look for passion, perseverance and both a physical and emotional investment in health care. Merkin says the group encourages action. “Ideas with no action are just like no ideas at all. We encourage people to be different, we believe following the herd is a sure way to mediocrity.” To help improve patient experiences, Heritage encourages staff in the non-critical care departments to rotate through different positions so they gain a better overall view of the operations. “We’ve invested heavily in people and we feel our leaders have to shape our values of the company. The CEO’s personal involvement might have the single biggest impact on the company.”
Merkin goes on to explain how Heritage is an organization that is becoming increasingly relevant in the ongoing debate over health care reform. “I think we have the kind of coordinated care that includes all of the provider constituents, the health plans, the hospitals, the providers and the patients, and we can create cooperation between all parties. This type of model I believe will be able to solve a lot of the health care issues currently facing the US.”
-by Jacqueline Rupp