leveraging the benefits of rural network alliances
DESCRIPTION
PYA Principals Jeff Ellis and Martie Ross demonstrate an approach to value-based care through healthcare collaboration in the presentation, “Leveraging the Benefits of Rural Network Alliances.”TRANSCRIPT
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Leveraging the Benefits of Rural Network Alliances
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Rural Communities
Residents are older, sicker, poorer, more likely to be
uninsured, have higher
healthcare costs
Fiercely independent
Access to healthcare key
to survival
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Rural Healthcare
Pursue strategy of local service delivery
High fixed costs/low volume
Current payment systems unravelling
No defined strategy for payment and delivery system reform
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Consolidate or Close or . . .?C
ap
ita
l In
ve
stm
en
t
Loss of Control
Minority
Investment
Joint Venture
Management
Agreement
Joint Operating
Agreement
Asset
Purchase/Acquisition
Lease
Merger/
Membership
Substitution
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The Third Way
SSOC
Shared Services
Operating Company
CSOC
Care System
Operations Company
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Shared Services Operating Company
• Governance structure to support decision-making process
Independent providers form new company
• Group purchasing arrangements
• Combine administrative functions
• Coordinated IT solutions
• Share best practices
Leverage resources and
pursue economies of
scale
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SSOC Examples
Stratus Healthcare (Georgia)
Value Care Alliance (Connecticut)
Trivergent Health Alliance (Maryland)
Illinois Rural Community Care Organization
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Planned Evolution
Population health
management
Clinical integration
Joint contracting
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But What’s Missing?
Still focused on local delivery of care
Not addressing continuum
of care
Still operating
in silos
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Triple AimThree Dimensions of Value
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•
Sick Care Population
Health
Bringing Value to Healthcare
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Provider-Centered
Patient-Centered
Sick Care Population Health
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Diagnose and treat
presenting illness or
injury
Address preventive and
chronic care needs of specific
population
Sick Care Population Health
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Fee-for-Service Reimbursement
Value-Based Payment Models
Sick Care Population Health
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Risk Resides with Payer
Risk Resides with Provider
Sick Care Population Health
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ProviderSilos
Systems of Care
Sick Care Population Health
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Single provider
treats one patient at a
time
Providers in collaboration
support health of defined population
Silo System
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Care System Operations Company
• Extended group with similar interests or concerns who interact and remain in informal contact for mutual assistance or support
Network
• Regularly interacting or interdependent group of items forming a unified whole
System
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CSOC Characteristics
• Vehicle for independent providers to form system of care
• Collaborative decision-making through new governance structure– Define population served
– Establish continuum of care
– Define each participant’s role in that continuum
– Identify and secure necessary resources
– Align incentives
– Require accountability
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CSOC Survey
University of Iowa Health Alliance
Health Network of Missouri
Kansas Heart and Stroke Collaborative
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University of Iowa Health Alliance
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University of Iowa Health Alliance • Transition primary care practices to
PCMH model
• Establish evidence-based medicine standards of care
• Pursue programs to determine/address health status of communities
• Develop provider educational programs
• Pursue patient engagement strategies
• Share IT and data analytics costs
• Collaborate in research initiatives
• Position organizations to participate in new payment models
Formed in 2012 among 4
health systems (50 hospitals); provider
network for Iowa/NE CO-
OP
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Health Network of Missouri
Academic medical center + 4
community hospitals
2+ years as learning collaborative
Formed new entity in June 2014 to
develop clinically integrated network
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Network Compacts
Covenants among all Members
Developed and operationalized by task forces comprised of Member representatives
Specific charges to task forces developed through Steering Committee planning process
Interactive and mutually supportive
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Member Contracts
Vehicle for arrangements between less than all Members
Allows Alliance to move expeditiously on matters of interest to individual Member groupings
Network Compact development takes priority, but can pursue Member Contracts at same time
Transparency between Members about work being done under Member Contracts
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MD Anderson, Mayo, Cleveland Clinic
• Franchise reputation
– Control vs. collaboration
• Disease specific (cancer, heart)
• Continuum of care?
• Reach out to rural?
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Kansas Heart and Stroke Collaborative
University of Kansas Hospital received $12.5 million Health Care Innovation Award
Develop rural clinically integrated network involving AMC, rural tertiary care center, 10
CAHs, FQHC, and providers at all facilities
Focus on regional systems of care for patients at risk of or who have suffered
heart attack or stroke
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The Kansas Heart and Stroke Collaborative is a care delivery and payment model to improve rural Kansans’ heart health and stroke outcomes and reduce total cost of
care for that population.
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Overarching Strategies
Integration(Teamwork)
Incentives(Rewards forTeamwork + Fieldwork)
Interventions(Fieldwork)
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IncentivesRewards for Teamwork & Field Work
• Direct payment for care management services
• Upward payment adjustments for participating rural physicians and mid-level providers
• Disease-specific shared savings program
Transitional payment model
• Build shared analytic infrastructure to identify and evaluate alternatives to cost-based reimbursement to preserve local access to care
Transformational payment model
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Commit to Action
• Shared vision
• Balance interests (common vs. individual)
• Committed resources
– Time and energy
– Financial
• Accountability
• Trusting environment
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SSOC/CSOC Phases
Strategy Development
• Engage in level-setting education
• Define rationale and objectives
• Determine scope
• Examine feasibility
Partner Assessment
• Develop selection criteria
• Perform SWOT analysis
• Enter into letters of intent
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SSOC/CSOC Phases
Establish Terms of Relationship
• Prioritize objectives
• Document rights and responsibilities
Commence/ Maintain Relationship
• Strategic and operational planning
• Secure IT infrastructure
• Develop timelines and link resources
• Identify performance measures
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SSOC/CSOC Phases
Pursue New Opportunities
• Joint contracting
• Relationships with other networks
Exit Strategy
• Specify triggers
• Determine procedures to wind down alliance
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How Structure Facilitates Organization’s Function
Provides structured environment for
discussion and decision
Promotes trust and transparency
Balances power among diverse
participants
Protects individual rights and concerns
Facilitates joint decision-making in a
safe environment
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Key Elements of an Effective Structure
Balanced time/energy/economic investments by participants
Balanced voting rights/reserved powers for participants
Shared vision and goals while recognizing “sacred cows” to be protected
Formal but flexible and adaptable rules of operation
Provides fair opportunity for participants to engage and be heard
Allows for organizational change/growth to address evolution of function
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Pershing Yoakley & Associates, PC9900 W. 109th Street, Suite 130
Overland Park, KS 66210913.232.5145
Jeff [email protected]
Martie [email protected]