The FMBHP is a collaboration among frontier/rural healthcare communities; Mineral Community Hospital’s Interdisciplinary Medical Education Center; iVantage, an industry leader providing comprehensive hospital evaluation tools; Mayo Clinic’s Practice-Based Research Network (PBRN); and the Appalachian Osteopathic Postgraduate Training Institute Consortium (A-OPTIC). The FMBHP will partner with CMS, IHS, Veteran Administration and other private insurers to develop a seamless and sustainable model of patient-centered and community-based healthcare that produces better outcomes cost-effectively.

1. Frontier Medicine Better Health Partnership
CMS Health Care Innovation Challenge
Kick-off Meeting
August 7, 2012
www.FMBHP.org

2. Frontier Medicine Better Health Partnership
CMS Health Care Innovation Challenge
Disclaimer:
The project described was supported by Funding Opportunity Number CMS-1C1-12-0001
from Centers for Medicare and Medicaid Services, Center for Medicare and Medicaid
Innovation.
Our content is solely the responsibility of the authors and does not necessarily represent the
official views of HHS or any of its agencies.”
As stated in the Programmatic Terms and Conditions; “if the Recipient plans to issue any
communication concerning the outcome of HHS grant-supported activities, it must notify
CMMI through its CMS PO in advance to allow for coordination. One copy of each
publication, regardless of format, resulting from work performed under an HHS cooperative
agreement -supported project must accompany the annual or final progress report submitted
to CMMI through its CMS PO”.

3. Montana’s Frontier Medicine Better Health Partnership
(FMBHP) was one of 80 (out of 3,000 applications ) awarded
Innovation Challenge funding. 3
 As described in the final awarded application:
 Geographic Reach: 25 Critical Access Hospitals statewide.
 Budget: $10,499,889
 Estimated 3-Year Medicare Savings: $31,922,800
 Serving: 100,000 beneficiaries of Medicare, Medicaid, and
the Children’s Health Insurance Program (by the end of year
three).
 Project Goal:
 To improve health outcomes for frontier and rural populations,
patients, and communities while lowering total expenditures
and improving patient satisfaction.

4. Guiding principles:
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 Rural and frontier communities need a voice in
identifying and addressing health care needs.
 CAHs and RHCs are vital components in the health of
their communities.
 Community-engagement coupled with robust data
collection, monitoring, benchmarking, and evaluation is
key to successfully addressing community health needs.
 Providing appropriate health care locally will increase
access and patient satisfaction, improve quality and
decrease costs.
 To meet future needs, the workforce must be trained and
redeployed to better support patients in lower cost and
community based settings.

5. Three strategies will guide FMBHP’s work:
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 Establish and sustain an innovative, evidence-based,
community responsive clinical infrastructure.
 Ensure the “right care, at the right time, by the right
provider”, such that access is improved and costs are
reduced.
 Develop the technical resources to train and deploy
providers and other workforce to meet identified needs.

6. Proposed FMBHP organizational structure and
governance:
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 Separate, not for profit, bylaws being formed:
 13 member board
 3 members each from Eastern, Central, and Western
portions of the State.
 2 users/1 non-health care worker.
 1 member from MRHC (the applicant).
 1 member each from Mayo, iVantage, and A-OPTIC.
 MRHC is legal applicant.

7. Partner – Mayo Clinic
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 Support community-engagement process in each of the
participating communities.
 Drive quality monitoring and improvement systems. and
 Identify health care and health workforce needs in each
community.
 Assist in development of local Community Collaboratives
to design best practice systems of health care in each
local community.
 Training resources.
 Community Engaged Practice Based Research Network.
 Lean Thinking.
 Continuous Education Opportunities.

8. Partner – A-OPTIC
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 Expand A-OPTIC’s current distance learning platform to
support the educational needs of participating providers.
 Support for Tier 1 courses focused on the training of the
Better Health Improvement Specialists – QI, HIT,
Workforce Development, Lean Thinking, etc.
 Support the development of the Learning Center at
MRHC and the Advanced EHR Training and
Development Center.

9. Partner - iVantage
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 Provide a clinical and functional baseline, monitoring,
benchmarking, and reporting resource for each of the
participating sites.
 Conduct Rural Operational Assessment for each site
Establish CAH-cost baseline, median/mean
performance, and practice leaders.
 Provide access to the iVantage Knowledge Web for each
participating site to facilitate best practice sharing.

10. What will each participating CAH receive?
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 Hospital Strength Index and Rural Operations Assessment
(iVantage).
 Hospital specific cost position and trends, FTE excess, and top
10 excess functions.
 “Better Health/Better Care Plan” and technical support to
implement.
 Updated annually.
 Facilitated best practice sharing.
 Directed quality improvement training.
 Assistance in recruiting a local Better Health Improvement
Specialist FTE and funding for the position.

11. iVantage’s data tools are increasingly sought out
by policy makers and providers.
11

12. What will each participating CAH receive?
12
 Access to an Advanced EHR Training (based at Barrett
Hospital).
 Best practice, meaningful use support.
 Access to Learning Center at Mineral Community
Hospital (which includes curriculum and faculty from
OPTI).
 Opportunities for regular communication between CAHs,
Regional Providers, and Partners, including best practice
identification and sharing and coordination of services.
 An ED Transfer Communication protocol and training to
lead to better care transitions, less errors, better
outcomes, and reduced cost.

13. What will happen in the next six months?
13
 Hire/Appoint Project Staff: Project Director, CMO,
Education Director, BHIS Director, HR.
 Marketing and communications plan.
 Finalize business model, policies, and procedures for the
FMBHP – including finalization of job descriptions and
reporting relationships.
 Finalize CAHs (Year 1 and 2 – 10 annually, year 3 – 5).

14. What will happen in the next six months?
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 Work with year 1 CAHs to recruit local BHIS.
 Provide training HIT, QI, and Community Engagement.
 Establish EHR Training and Development Center.
 Create baseline for participating CAHs.
 Hospital Strength Index.
 Provide Rural Operational Assessment, identifying cost
comparison and trends on specific cost groupings (iVantage).
 Conduct baseline performance evaluation for each CAH and
establish benchmarks for each performance indicator.
 Conduct a detailed facility assessment of each site using Lean
Principles including workflows, position
description/processes.
 ED transfer communication implementation.

15. What will happen in the next six months?
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 Establish Community Collaboratives – likely 6-10
organizations within each participating community.
 Identify health priorities, needs, and desired outcomes.
 A strategic operational plan (a BHBC Plan) including specific
goals, tactics, and measurements for monitoring results.
 Develop an overall BHBC Plan for FMBHP – identify
commonalities in issues between facilities, unique
issues/trends and identify top priorities that that
improve care/lower cost.

16. FMBHP Results
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 Realizing the Triple Aim –
 Better Care/Better Health
 Cost Efficiency
 Higher Patient Satisfaction
 CAHs will have a unified data-driven voice to affect
change.
 Sustainable Continuous Quality Improvement.
 Grow Montana’s provider base.
 Movement towards CCO.

17. Discussion
Questions?
THE PROJECT DESCRIBED WAS SUPPORTED BY FUNDING OPPORTUNITY NUMBE R
CMS-1C1-12-0001 FROM CENTERS FOR MEDICARE AND MEDICAID SERVICES,
CENTER FOR MEDICARE AND MEDICAID INNOVATION.
THE CONTENTS ARE SOLELY THE RESPONSIBILITY OF THE AUTHORS AND DO NOT
NECESSARILY REPRESENT THE OFFICIAL VIEWS OF HHS OR ANY OF ITS
AGENCIES.