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.”

1. Leveraging the Benefits of
Rural Network Alliances

2. Rural Communities
Residents are
older, sicker,
poorer, more
likely to be
uninsured, have
higher
healthcare costs
Fiercely
independent
Access to
healthcare key
to survival

3. 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

4. Consolidate or Close or . . .?
Capital Investment
Joint Operating
Agreement
Loss of Control
Minority
Investment
Joint Venture
Management
Agreement
Asset
Purchase/Acquisition
Lease
Merger/
Membership
Substitution

5. The Third Way
SSOC
Shared
Services
Operating
Company
CSOC
Care
System
Operations
Company

6. 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

7. SSOC Examples
Stratus Healthcare (Georgia)
Value Care Alliance (Connecticut)
Trivergent Health Alliance (Maryland)
Illinois Rural Community Care Organization

8. Planned Evolution
Population
health
management
Clinical
integration
Joint
contracting

9. But What’s Missing?
Still
focused
on local
delivery
of care
Not
Still
operating
in silos
addressing
continuum
of care

10. Triple Aim
Three Dimensions of Value

11. Bringing Value to Healthcare
•
Sick Care
Population
Health

12. Sick Care Population Health
Provider-
Centered
Patient-
Centered

13. Sick Care Population Health
Diagnose and
treat
presenting
illness or
injury
Address
preventive and
chronic care
needs of
specific
population

14. Sick Care Population Health
Fee-for-Service
Reimbursement
Value-Based
Payment Models

15. Sick Care Population Health
Risk Resides
with Payer
Risk Resides
with Provider

16. Sick Care Population Health
Provider
Silos
Systems of
Care

17. Silo System
Single
provider
treats one
patient at a
time
Providers in
collaboration
support health
of defined
population

18. 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

19. 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

20. CSOC Survey
University of Iowa Health Alliance
Health Network of Missouri
Kansas Heart and Stroke Collaborative

21. University of Iowa Health Alliance

22. 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

24. 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

26. 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

27. 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

28. MD Anderson, Mayo,
Cleveland Clinic
• Franchise reputation
– Control vs. collaboration
• Disease specific (cancer, heart)
• Continuum of care?
• Reach out to rural?

29. 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

30. 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.

31. Overarching Strategies
Integration
(Teamwork)
Incentives
(Rewards for
Teamwork +
Fieldwork)
Interventions
(Fieldwork)

33. Incentives
Rewards 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

34. Commit to Action
• Shared vision
• Balance interests (common vs. individual)
• Committed resources
– Time and energy
– Financial
• Accountability
• Trusting environment

35. 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

36. 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

37. SSOC/CSOC Phases
Pursue New
Opportunities
• Joint contracting
• Relationships with other networks
Exit Strategy
• Specify triggers
• Determine procedures to wind down
alliance

38. How Structure Facilitates
Organization’s Function
Provides structured
environment for
discussion and decision
Promotes trust and
transparency
Balances power
among diverse
participants
Facilitates joint
decision-making in a
safe environment
Protects individual
rights and concerns

39. 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

40. Pershing Yoakley & Associates, PC
9900 W. 109th Street, Suite 130
Overland Park, KS 66210
913.232.5145
Jeff Ellis
jellis@pyapc.com
Martie Ross
mross@pyapc.com