PROVIDER-BASED SYSTEMS: St. Joseph’s Provider Network Awarded Limited HMO License
St. Joseph's Provider Network became "the first hospital-based system in California to win a limited Knox-Keene license from state regulators," Modern Healthcare reports. The limited license, awarded by the state Department of Corporations, allows the network to negotiate capitated contracts for the five hospitals and 800 doctors affiliated with Stockton-based St. Joseph's Regional Health System, according to Steve Guasco, the network's director of managed care. With the license in hand, St. Joseph's, an affiliate of Catholic Healthcare West, can "control capitated contracts between providers in four central California counties -- Calaveras, Merced, San Joaquin and Stanislaus." Under renegotiated contracts with health plans, the provider network "will manage provider contracts and perform credentialing and quality audits," while the HMOs will be responsible for "enrollment, benefit design, sales and marketing and regulatory matters."
Get Your Knox-Keene
The limited Knox-Keene license is required for provider-based systems like St. Joseph's "that want to take on some of the risks of an insurance company through globally capitated contracts," Modern Healthcare notes. Besides St. Joseph's, Department of Corporations spokesperson Julie Steward said six other provider networks have been awarded a limited Knox-Keene license, including FPA Medical Management, MedPartners and Brown & Toland Medical Group. An additional 15 applications are pending, including ones from Cedars-Sinai Medical Center in Los Angeles and Scripps Clinic Health Plan Services in La Jolla (Rauber, 6/29 issue).