2014 Rural Hospital

Conference

The Cost of Doing Nothing is Too High

So, how do we partner to influence the health of our communities?

3

Our Mission

Connect Collaborate Achieve

 To improve the health care

delivery systems of our rural communities.

Skyline Hospital,

White Salmon

Who we are…4

Adams

Asotin

ChelanClallam

Clark

ColumbiaCowlitz

Douglas

FranklinGarfield

Grant

Grays Harbor

Island

Jefferson

King

Kitsap

Kittitas

Klickitat

Lewis

Mason

Pacific

Thurston

Lincoln

Okanogan PendOreille

Pierce

San Juan

Skagit

Skamania

Snohomish

Spokane

Stevens

WahkiakumWalla Walla

BentonYakima

Ferry

Mason General Hospital, Shelton

Whatcom

Whitman

Willapa Harbor Hospital, South Bend

Snoqualmie Valley Hospital

PeaceHealth United General Hospital, Sedro Woolley

Ocean Beach Hospital,Ilwaco

Forks Community

Hospital

Whidbey General Hospital, Coupeville

Summit Pacific Medical Center, Elma

Jefferson Healthcare, Port Townsend

Morton General Hospital

Prosser Memorial Hospital, ProsserKlickitat Valley Health,

Goldendale

5

Board of Directors Renée Jensen, Chair, Summit Pacific Medical Center

Kendall Sawa, Vice Chair, Ocean Beach Hospital

Rodger McCollum, Secretary/Treasurer, Snoqualmie Valley Hospital

Jim Chaney, Forks Community Hospital

Hilary Whittington, Jefferson Healthcare

Leslie Hiebert, Klickitat Valley Health

Eric Moll, Mason General Hospital

Tim Cournyer, Morton General Hospital

Jim Barnhart, PeaceHealth United General Medical Center

Julie Petersen, PMH Medical Center

Robb Kimmes, Skyline Hospital

Tom Tomasino, Whidbey General Hospital

Carole Halsan, Willapa Harbor Hospital

6

Strengths and Values

Membership is strong and committed Leadership team that meets monthly Expanded subcommittees to promote valuable exchanges:

CFO, Nursing, Quality, HR, HIM, CMO, Business Office Professional growth for leaders Synergy to discuss and develop ideas Forum for education

Work aligns and supports members missions Flexible and nimble Able to respond quickly to opportunities Maximize the value of collaborative as affiliate partner

Promotes efficiencies Grants Shared contracting (Lab, Insurance, Compliance Hotline, ICD 10

Training)

7

What we do… Convene hospitals for mutual support, exploration, development,

preparation and implementation: Innovation – tele-psychiatry, referral management, wellness program Piloting new models – HIE and Rural ACO Health care reform: Exchanges and Medicaid

Seek to reduce the unit cost of care for participating organizations Joint contracts/negotiations: Reference lab, PACS Shared services: ComplianceHotline, ICD 10 training

Sharing innovative programs and share best practices among members Policies and procedures, cardiac and stroke guidelines, compliance Reviews and reports on the status of quality measures and initiatives Quality and critical access hospital requirements, as well as expanding

services such as cardiology clinics and education.

8

Current Activities… Strategic Focus 2014: Establish a Performance Quality Improvement Initiative

Focus on both clinical quality and financial measures Goals:

Develop standardized benchmarking tools dashboards and metrics Develop a process for quality and financial performance improvement across multiple hospitals Explore models to scale PI through regional collaboratives (both formal and informal) and Statewide initiatives Based on opportunities identified through benchmarking, complete at least one PI project (including an

evaluation of the financial impact) during 2014 Partners: DOH , Office of Rural Health, WSHA, Terry Hill, NRHA

Bargaining/Benchmarking/Joint Contracting Benchmarking: ED FTE/Visits, medication errors, staffing ratios tied volumes Compliance Hotline ICD 10 Training Contract Insurance contracting through PHD Joint Operating Board (WRHC is Administrative/Fiscal Agent) Joint Contracting Underway:

Lab: Estimated savings of $850,000 annually GPO PACS Malpractice Insurance

Preparing for and implementing health care reform Maximize the value collaborative as a affiliate partner Preparing for a shift from volume to value based purchasing Exploration of forming a rural ACO HRSA HIT Grant – preparing hospitals to achieve meaningful use

Access to Resources: Shared services, best practices and learnings Active Committees: CEO, CFO, Nursing & Quality, HR, HIM, Marketing and Foundation, Compliance , emerging

CMO

9

PHD Joint Operating Board

Skyline Hospital,

White Salmon

PHD Joint Operating Board

10

Adams

Asotin

ChelanClallam

Clark

ColumbiaCowlitz

Douglas

FranklinGarfield

Grant

Grays Harbor

Island

Jefferson

King

Kitsap

Kittitas

Klickitat

Lewis

Mason

Pacific

Thurston

Lincoln

Okanogan PendOreille

Pierce

San Juan

Skagit

Skamania

Snohomish

Spokane

Stevens

WahkiakumWalla Walla

BentonYakima

Ferry

Mason General Hospital, Shelton

Whatcom

Whitman

Willapa Harbor Hospital, South Bend

Snoqualmie Valley Hospital, Snoqualmie

Ocean Beach Hospital,Ilwaco

Forks Community

Hospital, Forks

Whidbey General Hospital, Coupeville

Summit Pacific Medical Center, Elma

Jefferson Healthcare, Port Townsend

Morton General Hospital, Morton

Prosser Memorial Hospital, Prosser

Cascade Valley Hospital, Arlington

Skagit Valley Hospital, Mt. Vernon

Valley General Hospital, Monroe

Island Hospital, Anacortes

Klickitat Valley Health, Goldendale

Lincoln Hospital, Davenport

Newport Hospital, Newport

11

PHD Joint Operating Board Established in 2006 Contracts with WRHC to provide fiscal and

administrative support and leadership Authorized under RCW 70.44.240 and RCW

70.44.450 18 Public Hospital District hospitals have entered into

an Interlocal Agreement, under the name PHD Joint Operating Board, authorizing collective negotiations with public and private health plans and provider groups.

Governance Structure Board: 18 Public Hospital Districts Chair: Tamara Cesena, Skagit Regional Health Volunteer board with bylaws and clear participation

agreements

12

Our Goals To create economies of scales through a

centralized contract negotiations process. Enhance the expertise of contract negotiations. Add resources to enable faster, more sophisticated

interactions with insurance carriers. Poise member public hospital districts in a stable

position for the Health Insurance Exchange and Risk-Based/Value Based Contracting.

Share the lessons learned, processes and tools.

13

Current Activities

Develop and analyze models and strategies to negotiate, enter into and carry out joint agreements and contracts for health care service delivery and payment with public and private entities that operate within the State of Washington.

Engage in other collective negotiations with health plans or provider groups desiring to contract in the State of Washington;

Exploring models related to value-based and risk-based contracting and

Engage consultants as PHD deems necessary to assist in evaluating the various models and strategies under consideration.

Member advocacy Share the lessons learned, processes and tools

14

Flex Activities 2013 -2014

Year 1: Develop the framework and necessary infrastructure

to effectively develop and implement a joint contracting model that is compliant with Washington State laws.

Year 2: Convene a financial network to identify and share best

practices for negotiating contracts with health plans and language and rates among our members with a specific focus on creating the organizational readiness and potential responses to valued based contracting

15

Questions?

Contact for further information:

Holly Greenwood, Executive Director,Washington Rural Health Collaborative PHD Joint Operating Board (360) 346-2351holly@washingtonruralhealth.orgwww.washingtonruralhealth.org