Case Study: AppleCare Medical Group achieves advanced risk management and readiness for value-based reimbursement with Optum360

Advanced risk management, operational excellence and top-tier service position AppleCare for value-based reimbursement

AppleCare Medical Group, an independent practice association (IPA) in Southern California that manages care for about 100,000 HMO members, faced the industry-wide shift from volume-based to value-based reimbursement and needed stronger data, analytics and operational support to model and bear financial risk. To address that challenge, AppleCare partnered with Optum360 and joined Optum’s Collaborative Care delivery system to access advanced analytics and technology for clinical and financial risk modeling.

Optum360’s data and technology were integrated with AppleCare’s provider‑centric culture and care‑management infrastructure (hospitalists, nurse case managers, social workers, pharmacists and medical directors) to optimize utilization, coordinate care and better stratify risk. As a result, AppleCare expanded access to managed‑care contracts, stabilized physician income and strengthened its risk‑bearing capability across roughly 450 primary care physicians in 300 locations—building on an 18‑year track record of managing ~100,000 members and positioning the IPA for further growth under value‑based reimbursement.

AppleCare Medical Group

Vinod Jivrajka

President & CEO