SOURCE: ConcertoHealth, Inc.

ConcertoHealth, Inc.

September 16, 2015 09:05 ET

ConcertoHealth, Inc. (Formerly Fidelis SeniorCare) Launches Transition to Focus on Dual-Eligible Medicare & Medicaid Patient Care Model

Divests Insurance Assets, Names New Executive Team and Relocates Headquarters

IRVINE, CA--(Marketwired - Sep 16, 2015) - ConcertoHealth, Inc. (formerly Fidelis SeniorCare) today announced it has divested its insurance assets to focus solely on expanding its innovative healthcare delivery model for dual-eligible Medicare and Medicaid patients. The company has relocated its headquarters to Irvine, CA, from Schaumburg, IL, and assembled a new executive leadership team from many of the nation's leading healthcare companies. 

ConcertoHealth has more than a decade of experience caring for Medicare, Medicaid and complex medical needs patients. The company gained a deep understanding of the complexities involved with healthcare delivery and financial risk management of these patient populations during its long tenure operating as both a Medicare Advantage health plan, Fidelis SecureCare, and as a care provider through the Fidelis SecureHome medical centers.

ConcertoHealth sold Fidelis SecureCare of Michigan, Inc. to Centene Corporation (NYSE: CNC) and Fidelis SecureCare of North Carolina, Inc. and Fidelis SecureCare of Texas, Inc. to FHP Insurance Holding Co., Inc. (Fresenius Health Partners) in transactions completed earlier this year. These divestitures allow ConcertoHealth to focus solely on expanding its medical home and care coordination model delivered through its Concerto Medical Centers. 

ConcertoHealth has relocated its headquarters to Irvine, Calif., and projects that by year-end it will have approximately 285 employees combined including the headquarters and its Seattle and Detroit markets, up from just 79 employees in 2014.

New Management Team
A new leadership team with broad industry experience will lead the company. 

  • Alec Cunningham, Chief Executive Officer, joined ConcertoHealth in 2014. He previously served as Chief Executive Officer of WellCare Health Plans.
  • Michael Carson, Chief Operating Officer, was formerly President of Anthem's Eastern Region Medicare business.
  • Toby Thomas, Chief Financial Officer, has been with ConcertoHealth since 2013. He previously served as President of Advanced ICU Care and Chief Financial Officer for Cogent Healthcare.
  • Stephanie Griffin, Chief Compliance Officer, joins the company from CommuniCare where she served as Compliance Counsel /Chief Compliance Officer/Privacy & Security Officer.
  • Bob Wilson, Chief Human Resources Officer, comes to ConcertoHealthfrom Healogics where he served as Executive Vice President of Human Resources and Administration.
  • Colin LeClair, Senior Vice President Business and Product Development, was formerly Senior Vice President of Accountable Care for Monarch Healthcare/Optum.

"We have assembled a dynamic management team with the experience and competency to help drive rapid growth of ConcertoHealth nationwide," said Alec Cunningham, Chief Executive Officer.

The Model
ConcertoHealth offers solutions to several critical vulnerabilities for patients and health plans alike -- expanded access to personalized primary care, chronic condition management, and coordination of transitions between care settings. 

ConcertoHealth's model provides patients with healthcare services where and when they need them, eliminating the most common barriers to appropriate and timely care. By merging social work with care management, ConcertoHealth improves access to primary care services by building medical centers in the communities it serves, addressing both the social and economic realities these patients face.

The ConcertoHealth model includes:

  • ConcertoHealthMedical Centers staffed by physicians, nurses, social workers, medical assistants, and pharmacy staff, in addition to social and community services support, patient outreach and health education;
  • ConcertoHealth Care Coordination for each patient available 24-hours, 7-days a week including in-home care for non-ambulatory patients, bedside patient management in hospital or post-acute settings, and management of transitions between care settings;
  • Chronic disease management and comprehensive preventive screenings, access to non-emergent transportation, as well as prescription assistance, the absence of which are key barriers to healthcare services.

"Healthcare reform has created substantial opportunities for us," said Cunningham. "The expanded coverage and the ability to test innovative models against the backdrop of a rapidly growing aging population are all coming together to help us grow our operations."

Growth and Expansion

The success of ConcertoHealth's model was the basis for its selection by the State of Michigan Duals Demonstration Medicare-Medicaid Plan (MMP) program. In addition to two existing Concerto medical centers in Seattle and Detroit, the company recently opened three additional centers in Detroit and hired nearly 200 local market employees, infusing both capital and new jobs into the Detroit metro area.

"As both an investor and Michigander, I am pleased to be associated with ConcertoHealth. The ConcertoHealth model addresses both the medical and social needs of its patients, and directly supports Michigan's initiative to provide comprehensive, superior-quality and cost-effective care for the Medicare and Medicaid populations of the state," said Tim Petersen, Managing Director for Arboretum Ventures and Chairman of the ConcertoHealth Board of Directors.

The Need

  • Representing only 20% of the population, dual-eligible patients consume 34% of Medicare spending and 40% of state Medicaid spending -- more than $300 billion annually.
  • On average, total spending for dual-eligible beneficiaries is about twice that for non-dual-eligible beneficiaries.
  • The costliest 20% of dual-eligible beneficiaries are the most clinically complex, consuming 63% of total spending on these patients.
  • 79% of dual-eligible beneficiaries remain enrolled in Medicare Fee-for-Service.
  • Dual-eligible enrollment in Medicare Advantage Dual Special Needs Plans has grown 251% since 2007.
  • The Medicaid-Medicare Coordination Office reported that between 2006 and 2011, the total number of dual-eligible beneficiaries increased by 17.7%, from 8.6 million to 10.2 million.
  • Dual-eligible patient population growth is expected to accelerate with the expansion of Medicaid eligibility and the aging of the baby boomer generation.

About ConcertoHealth
ConcertoHealth Inc. has more than a decade of experience caring for the Medicare, Medicaid, frail and complex medical needs patient populations. The company addresses critical vulnerabilities for patients and health plans alike: expanded access to personalized primary care, chronic condition management and coordination of transitions between care settings. Through its ConcertoHealth Medical Centers, the company provides healthcare services where and when they're needed, delivering primary care and care coordination regardless the location -- be it clinic, home, hospital or post-acute settings. The company is headquartered in Irvine, Calif. For more information, please visit www.concertohealthcare.com.