^{An Industry Leader In The Competitive Managed Care Arena}

OVERVIEW

La Vida Medical Group & IPA is a privately owned physician organization providing medical care to patients throughout Los Angeles County. The company’s roots began in 1985 with a small network of physicians dedicated to providing superior care in the emerging managed care industry. Today, the organization has grown into a powerful network of about 3,500 physicians, working to optimize the delivery of medical services in today’s complex health care marketplace.  La Vida’s provider network has a common mission: To provide high quality health care to an ethnically and culturally diverse population, more cost effectively, and with a higher level of service and caring than is available anywhere in Southern California.

 

La Vida is contracted with more than 450 primary care and over 3,000 specialist physicians, to provide care to members of more than 15 health care plans.  Currently, La Vida has about 200,000 members, placing it in the ranks of the largest and most sophisticated physician groups in the region.

 

La Vida’s current record increase in membership is largely due to the growth of its provider network, which is hand picked and unique. Solo-practitioners who have been providing care to Los Angeles County residents for many years, account for upwards of 90% of La Vida’s provider network.  In addition, they reflect the ethnic and cultural diversity of the communities in which they serve.

 

The economic realities of today’s health care marketplace have given rise to fierce competition and profit margins that are slim, at best. There is constant attrition in the number of health plans and health care providers due to increased regulatory pressure. Instability, insolvency, forced acquisitions and mergers, have become the order of the day in an erstwhile benign environment.

 

Despite rate freezes and industry cutbacks, La Vida has remained an extremely viable enterprise, without skimping on quality, service, or excellence. Our providers and ultimately, our patients, have been the real beneficiaries of the stability and growth, which are direct outcomes of the La Vida way of doing business- by Bringing Quality to Life!                 

Cutting-edge Technology 

La Vida is proud to be a leader in medical information systems. We realize what others don’t- “most physicians want to focus on providing care to their patients, not maneuvering through bureaucratic red tape...” La Vida has responded to this need by developing state-of-the-art information distribution systems to alleviate the administrative burden on the physician.

 

The offices of our primary care physicians are equipped with the La Vida Net systems. Although equipped with patent-ready software, this user-friendly system offers physicians fast, reliable, access to eligibility information, authorizations and billing, while providing encounter data to the IPA. This technology is currently available at 140 physician locations that combined, account for over 60% of La Vida’s membership. Additional installations are constantly being implemented, in our bid to remain at the forefront of the managed care delivery system.

 

Superior Customer Service  

 

La Vida offers superior customer service to its physicians and members and is committed to a “personal touch” approach to health care.  Contracted physicians can expect phone calls to be returned the same day. Authorizations are approved and distributed in a timely manner.  Claims for services are paid accurately and within 30 to 45 days of receipt.  La Vida encourages physician participation in IPA decisions through voluntary weekly meetings at area hospitals.  Any member who calls La Vida Medical Group & IPA can expect to be treated with utmost courtesy and respect.

 

 PRODUCTS & SERVICES

 

Core Business Function 

 

La Vida Medical Group & IPA capitalized on its depth of experience and expertise, in developing its core business functions, which include:

 

  Information Management.

      La Vida’s reliance on information processing as an integral part of Quality Service and Delivery dictated the development of a proprietary system to generate, organize, and utilize member and provider data banks. Designed to operate in a scalable and dynamic environment, it adroitly maneuvers through multiple tasks of effective IPA management, including: Electronic Eligibility (including member eligibility history and demographics; Authorization Tracking System; Claims Analysis; Credentialing Access and Document Repository; Real Time Financial Reporting; as well as Electronic Exchange & Communications. In terms of clinical management, La Vida physicians have at their disposal, information that had previously been inaccessible, enabling them to expertly disburse care among a diverse patient population, without a decrease in response time, detail, or quality. Using these tools, their resultant decisions have led to a marked decrease in incidents of avoidable hospitalization and unusually broad diagnostic parameters. By contrast, patient education and health maintenance procedures have shown a distinct upward trend.

     

       Most recently, La Vida incorporated a state of the art integrated healthcare management information system which essentially provides ease and agility of viewing / sharing pertinent information and data between La Vida, it's physicians, health plans and even patients, where appropriate. By so doing, La Vida stays true to it's innovativeness and willingness to adapt to positive changes in healthcare management well before they are mandated. Thus HCC coding, CCS patient identification, encounter-based chronic disease management, health and wellness education and more, will all be enhanced.

 

  Provider Contracting. 

      La Vida employs Regional Network Managers and Business Development Managers, who negotiate and service physician contracts with the key emphasis being on service. Unlike other groups where physicians are simply part of a numbers game, the signing of the contract is not the highlight but rather the beginning of a close partnership. Business Development Managers pride themselves in understanding and managing the key elements of successful working relationships with physicians. Our goal in each individualized contractual agreement is to launch a strong, successful relationship that will promote growth and longevity for both the physician and La Vida.  Once the physician is a part of the La Vida family, the Network Manager provides one on one, hands-on, on-site interaction on a monthly basis. This allows La Vida to keep its finger on the pulse of our providers’ needs, eliminating guesswork, while improving efficiency and response time. Although we have earned the trust of our physicians, we do not rest on our laurels. Through self-evaluation and objective feedback from our physicians, we hold ourselves accountable to the high standards of quality and personalized service we have set in the industry.

 

  Provider Credentialing.

      To ensure the very best care for our patients, La Vida institutes extensive background checks on physicians through electronic access to most Physician Reporting Agencies. Education and licenses are verified while malpractice complaints are carefully reviewed. In this manner, La Vida Medical Group & IPA has amassed the finest physician network, anywhere.

 

  Utilization and Quality Management.

      A sophisticated systems component, which automatically generates and faxes pertinent forms to the appropriate physician’s office, is at the heart of this department’s effectiveness and success. The Utilization Management (“UM”) team, processes authorizations and referrals with review by the Quality Management (“QM”) team, to ensure compliance with CMS, DMHC & health plan and health plan guidelines. La Vida retains highly trained nurses, available 24 hours a day, to assist in authorizing inpatient care. In addition, they actively monitor all hospitalized patients, on an ongoing basis, to ensure they are receiving appropriate care. The tracking capability of La Vida’s software also enables us to generate outcome analysis of inpatient admissions.  The QM staff assists our exclusive providers with facility site reviews to ensure patient safety and compliance with regulatory agencies. The UM/QM/Credentialing Departments are instrumental for provider appointments, submission of provider to health plans, Health Education, Culture and Linguistics, Grievances, and overall satisfaction with Quality Management services.  The QM/Credentialing Department has obtained delegation status with every health plan and received special commendation from LA Care.  The department has established productivity standards and usually exceeds these thresholds.

 

  Claims Processing. 

      La Vida processes approximately 400,000 claims annually using the EZ-Cap 4.1 system. La Vida’s Claims Department has received accolades from all of our contracted health plans for excellent audit scores on claims paid timely, efficiently and accurately. Check runs are weekly to all La Vida providers and it is a policy of La Vida Medical Group & IPA to ensure checks are mailed within 24 hours from the date of processing.  Contracted providers have the option to submit claims electronically.  Reporting capabilities include analysis of virtually any combination of the following elements: health plan, product type, provider, claim status, procedure, diagnosis, place of service, authorization, date received, entered, paid. When necessary, claims are easily matched to related authorizations for accurate computation of IBNR obligations.  La Vida is able to accept electronic claims submissions in NSF 2.0 format. Use of confidential log-ins and differing levels of access guarantees rigorous maintenance of system security for each cleared employee. In an aspect of the health care delivery system, where speed is of the essence but often comes at the cost of accuracy and due diligence, we are proud to stand head and shoulders above the rest.

 

  Eligibility Reporting.

      Each primary care physician’s Member Eligibility Lists are made available monthly and are interactively updated by La Vida and the participating physicians. From these lists, Capitation payments are computed and cross-referenced.  Salient features of La Vida’s Eligibility Department include verification of eligibility for most health plans on-line; same day turnaround of eligibility enquires; immediate phone response; detailed e-lists which are printed and mailed by the 10^th of every month.

 

  Encounter Data.

      La Vida boasts one of the most advanced encounter data collection systems in the industry. Primary care physicians have multiple options for electronic submission of encounter data to the IPA: through a “print-to-file” of their HCFA-1500 forms, submission of data in NSF 2.0 format, or through the use of La Vida’s computer systems, as described above.

 

CUSTOMERS & MARKETS SERVED

 

La Vida Medical Group & IPA serves a broad range of members in a variety of markets, from individuals eligible for Medicare to members of large employer groups.  All of our patients have a common need to receive high-quality health care in an expeditious manner. Health plans; physicians, and patients constitute our client base. In addition, La Vida maintains business partnerships with numerous area hospitals.

 

Contracted Health Plans

 

La Vida has contracts with 15 health plans to provide services to Commercial, Medicare and Medi-Cal members. This represents 200,000 or more people, whose lives are positively impacted by our dedication to Bringing Quality to Life! Our Honor Roll of V.I.P.s [Very Important Plans] in alphabetical order, includes:

 

Affiliated Hospitals

 

Some of the finest medical facilities in the region count on La Vida Medical Group & IPA as a solid “Go-to” partner in quality health care delivery. We are honored by the trust of the following V.I.P.s [Very Important Partners]:

 

  Catholic Healthcare West

St. Francis Medical Center

St. Vincent Medical Center

California Medical Center

Centinela Freeman Health Systems

Glendale Adventist Hospital

Glendale Memorial Hospital

Greater El Monte Hospital

Queen of Angels/Hollywood Presbyterian Hospital

St. Joseph's Medical Center

Suburban Medical Center

Memorial Hospital of Gardena

Long Beach Memorial Medical Center

Cedar Sinai Medical Center

Beverly Medical Center

Little Company of Mary Hospital

Little Company San Pedro Hospital

Garfield Medical Center

Monterey Park Hospital

 

 

Service Area

 

La Vida Medical Group & IPA is meticulously pursuing its goal of “blanketing the Southland with quality”. While eschewing uncontrolled growth, we have successfully planned and implemented expansion into these V.I.P.s [Very Important Places]:

 

  Hawthorne/Inglewood

  Compton/Watts

  Carson/Gardena

  Torrance

  Harbor City

  Wilmington

  Redondo Beach

  Long Beach

  South Central Los Angeles

  Downtown Los Angeles

  Lynwood

  San Gabriel Valley

  San Fernando Valley

  Glendale/ Burbank

  San Pedro