Aligning the healthcare system to deliver exceptional patient care: Alignment Healthcare

 In 2013, John Kao and a group of elite healthcare entrepreneurs formed Alignment Healthcare. Based in Orange County, California, the company has spread across the country to include offices and care centers in North Carolina and Florida. Alignment Healthcare is redefining the business of healthcare by shifting the focus from payments to people. It is a population health organization with an advanced clinical model, information technology and enablement systems, risk experience, and access to capital.

Kao, president and CEO, was intent on improving quality of care, while decreasing unnecessary costs. Kao and his team focused on eliminating inefficiencies, misaligned incentives, financial waste, and poor clinical outcomes, especially for the frail and chronically ill senior. The team realized by integrating with hospitals, physician groups, health plans and employers, they could build a smarter and better healthcare system for our communities.

The team’s combined experience provides an entire network of care for members and patients and reflects their commitment to shift the healthcare system to a fee-for-wellness model, one patient at a time.

The first step

Alignment entered the California payer market through an acquisition of a regional Medicare Advantage plan, now called Alignment Health Plan. In 2014, the company signed partnership agreements with UNC Health Care and Humana to offer a new model of care to Medicare beneficiaries in Wake County, North Carolina, designed to improve patient outcomes, increase quality of care, and reduce overall costs. Alignment’s core operations team also built, opened and staffed six freestanding care centers in both states.

Alignment Healthcare’s first venture outside of Southern California, Wake County taught the company lessons that applied to its second annual enrollment period in North Carolina as well as its newest extension, in Florida. Even though Alignment Healthcare was generally accepted by healthcare providers and consumers alike, the company failed to fully educate and engage their physician partners in the UNC Health Care system and out, in the importance of scheduling all members for an initial clinical assessment with Alignment and its outcomes. Requests for referrals and outreach to patients to schedule those assessments were treated with hostility by some providers, who interpreted actions as competitive. Alignment Healthcare has since invested in its staff to lead a coordinated member outreach program and local provider relations. The company is prioritizing the assessment of various methods to effectively explain Alignment Healthcare’s role in the healthcare ecosystem, and how it enables everyone involved to improve care for Medicare beneficiaries.

Health and satisfaction are the company’s driving force. The company provides unique access to its physicians that often go above and beyond the traditional concept. Alignment doctors spend an average of 60 minutes with new enrollees. Alignment has also invested in an online platform that helps members schedule appointments at care centers or in their homes. They also have an added a pharmacy benefit that provides a 100-day mail order prescription option instead of the typical 90-day program.

This is what sets Alignment Healthcare apart from the rest

Clinical Model- Alignment’s integrated, coordinated care model is designed to keep a senior population mobile and independent.

Vision- Alignment Healthcare is focused on changing healthcare one patient at a time. Every patient who goes through the company’s Jump Start health assessment has a better chance of proactive healthcare than someone going at it alone. The program is designed to address not only health issues such as clinical depression and chronic disease, but also socioeconomic factors that may affect the member’s well-being.

Technology Platform- The company has more than 200,000 proprietary algorithms that address complex cases or trigger alerts that can help prevent illness and save lives.

People- Talented company leaders and employees could work anywhere, but they choose to work at Alignment because of the company’s vision to serve the most vulnerable populations.

Partners- Alignment is working with some of the best partners in healthcare, including Ascension, Florida Blue, HCA, Humana, and  UNC Health Care.

Contributing the best to world-class IT firms

Alignment’s multi-pronged business model creates a positive continuum of care for members and patients, and it aligns every touch point a member or patient will encounter through his or her healthcare experience, improving communication among all stakeholders invested in the patient’s care. This approach and the combined services of health plan coverage, personal care management and technology significantly improve overall efficiency and reduce human error, while improving care, and decreasing cost. In late 2016, Alignment announced opening access to its technology platform to third parties for the first time through a care-as-a-service business unit called Alignment Health Services.

Five years down the lane

Alignment’s focus has been transforming healthcare delivery for Medicare beneficiaries, but the value created and lessons learned could, one day, be applied to the larger healthcare system. Through Alignment Health Services, partner companies will have access to Alignment’s clinical model and population health technology while taking on financial risk. Alignment’s first care-as-a-service partnership is being implemented in North Carolina. As more people realize the benefits of Alignment’s care delivery model, the company has set its sights on maintaining a steady rate of growth, to lead a movement that transforms healthcare, one person at a time.

Meet the brains behind Alignment Healthcare

JOHN KAO, Founder, CEO and President: John was president of Care More Medical Enterprises, Inc., and executive vice president at The TriZetto Group, an information technology company serving the health insurance market with over 125 health plans and 250 third-party administrator customers. He also served as president and CEO of the Ventures Division of PacifiCare Health Systems, and has over 25 years of healthcare experience. He received his Bachelor of Science degree from Santa Clara University and his MBA from the UCLA Anderson Graduate School of Management, where he was honored as a Venture Capital Fellow.

“A population health management solution for health systems and provider groups across the country.”