Riverside County Foundation For Medical Care

The organization created a fellowship program which serves as the foundational element of a first of a kind fully integrated population health fellowship program in the nation. The fellowship prepares primary care physicians from the start to lead interdisciplinary teams that challenge the status quo by developing and testing new strategies and workflows for optimizing the health and well-being of our communities. A comprehensive 12-month curriculum is included that covers key population health topics as well as structured assignments with measurable outcomes designed to transform provider and practice performance during the fellowship year. The program also offers loan forgiveness incentives to help reduce the pressures of student debt and eliminate the strain of low-paying fellowship programs.

The organization adopted a quality improvement program which supports primary care physicians who are contracted directly for their patients. The objective of the project is to help doctors improve quality measures and close gaps in care. Using a data analytics tool, the providers can access actionable data to improve patient care coordination, address chronic conditions, connect diagnostic coding, review pharmacy management, and address quality measures.

The organization works with practices and clinics to effectively connect with and screen difficult to reach patients while helping to systematically close care gaps in an efficient cost-effective manner, helping to maximize pay-for-performance incentives for these providers. Through a unique combination of strategic initiatives and state of the art analytics, the organization provides both guidance and support that extends from patient identification and scheduling to claims generation and troubleshooting.