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Oct 13, 2016

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Richard Lipeles joined PacifiCare in July 1979, and in 1987 he became President of PacifiCare of California. In 1993 he was promoted to Executive Vice President of PacifiCare Health Systems.

As Executive Vice President of PacifiCare Health Systems, Lipeles oversaw the corporation’s managed health care division, which included health plans in California, Florida, Oklahoma, Oregon, Texas, and Washington. Lipeles retired from PacifiCare September 1995.

As of June 2002, Lipeles joined the management team of Heritage Family of Companies as the company’s COO. Heritage provides medical care to more than 1,000,000 people in CA, NY, AZ, and MO.

For over 30 years HPN’s medical groups and IPAs have provided an award winning, comprehensive approach to care management. In December of 2011, through Heritage California ACO, Heritage was awarded a Pioneer ACO by CMS for 8 counties in Southern California.

Lipeles has a Masters of Public Health (M.P.H.) degree from the University of California, Los Angeles (UCLA), and a Bachelor of Science degree in business economics from the University of California, Riverside. Lipeles severed on the Advisory Board of the School of Public Health at UCLA for 8 years. He lives in Sunset Beach with his wife, and has 4 children and 5 grandchildren.

00:00 Rich talks about the Heritage Group.
02:25 Why the Heritage Group chose to pursue Managing Risk.
03:20 What it means to Manage Full Risk.
03:40 “Is the Health Plan taking Hospital Risk, or are we taking Hospital Risk?”
04:20 Incentivizing Hospital Risk Reduction.
05:30 The Essential Ingredients to Managing Risk.
06:00 Having relationships with local E.R. Doctors.
07:40 Having a strong PCP Network, and making sure that PCP Network is supported.
08:50 Stratifying and Identifying At-Risk Patients.
10:30 The Mistakes made when trying to Stratify Risk.
11:45 Looking at the Overall Patient.
12:00 Stripping Disease Management out of the equation.
13:00 How the Social Interaction is instrumental in producing outcomes.
14:00 Pulling off Healthcare on the local level while being very geographically dispersed.
16:40 Helping independent doctors remain independent.
20:00 The three ways to ‘hook up’ to the Heritage Group.
21:50 The Heritage Groups and IPAs.
22:30 Rich’s advice for someone embarking on Population Health Management.
24:45 Furthering Population Health aims.
27:10 You can learn more at