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The Third Way--Maintaining Independence Through Interdependence
The document discusses strategies for improving rural healthcare through interdependence among independent providers, highlighting shared services and collaborative governance structures to enhance care delivery and population health management. It emphasizes the need for new payment models and integration of services to address the challenges faced by rural communities, such as higher healthcare costs and poorer health outcomes. Various examples of collaborative networks and initiatives are presented, showcasing the importance of collective action in achieving better healthcare solutions.
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The Third Way--Maintaining Independence Through Interdependence
- 1. Page 1 TheThird Way Maintaining Independence Through Interdependence National Rural Health Association Critical Access Hospital Conference October 2, 2014 – Kansas City, MO
- 2. Page 2 RuralCommunities Residents are older, sicker, poorer, more likely to be uninsured, have higher healthcare costs Fiercely independent Access to healthcare key to survival
- 3. Page 3 RuralHealthcare 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. Page 4 Consolidateor Close or . . .? Capital Investment Joint Operating Agreement Loss of Control Minority Investment Joint Venture Management Agreement Asset Purchase/Acquisition Lease Merger/ Membership Substitution
- 5. Page 5 TheThird Way SSOC Shared Services Operating Company CSOC Clinical System Operations Company
- 6. Shared Services OperatingCompany Page 6 • 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. Page 7 SSOCExamples Stratus Healthcare (Georgia) Value Care Alliance (Connecticut) Trivergent Health Alliance (Maryland) Illinois Rural Community Care Organization
- 8. Page 8 Population health management Clinical integration Joint contracting Planned Evolution
- 9. Page 9 ButWhat’s Missing? Still focused on local delivery of care Not addressing continuum of care Still operating in silos
- 10. Page 10 TripleAim Three Dimensions of Value
- 11. Page 11 BringingValue to Healthcare Sick Care Population Health
- 12. Sick Care PopulationHealth Page 12 Provider- Centered Patient- Centered
- 13. Sick Care PopulationHealth Page 13 Diagnose and treat presenting illness or injury Address preventive and chronic care needs of specific population
- 14. Sick Care PopulationHealth Page 14 Fee-for-Service Reimbursement Value-Based Payment Models
- 15. Sick Care PopulationHealth Page 15 Risk Resides With Payer Risk Resides With Provider
- 16. Sick Care PopulationHealth Page 16 Provider Silos Systems of Care
- 17. Page 17 SiloSystem Single provider treats one patient at a time Providers in collaboration support health of defined population
- 18. Care System OperationsCompany • Extended group with similar interests or concerns who interact and remain in informal contact for mutual assistance or support Page 18 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 Page 19 – 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. Page 20 CSOCSurvey Vanderbilt Health Affiliated Network University of Iowa Health Alliance Health Network of Missouri Kansas Heart and Stroke Collaborative
- 21. Vanderbilt Health AllianceNetwork Page 21
- 22. Vanderbilt Health AffiliatedNetwork • Formed in September 2012 as Vanderbilt employee health plan • Expanded provider network to meet employees’ needs • Now expanding offering to other employers (Aetna and BCBS-TN) Page 22
- 23. VHAN - MountainStates Health Alliance • Share evidence-based care models • Collaborate in medical research and clinical trials • Develop consultative relationships among specialists and subspecialists • Support physician recruitment • Develop continuum of care in cardiovascular and oncology service lines • Develop narrow network for joint contracting Page 23 Affiliation agreement announced in May 2013
- 24. VHAN –West TennesseeHealthcare • Educational program support • Enhance delivery of oncology support programs for physicians and patients • Consultative services to build upon clinical programs • Joint clinical research trials Page 24 Cancer program affiliation agreement announced in May 2013
- 25. University of IowaHealth Alliance Page 25
- 26. University of IowaHealth 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 Page 26 Formed in 2012 among 4 health systems (50 hospitals); provider network for Iowa/NE CO-OP
- 27.
- 28. Page 28 HealthNetwork of Missouri Academic medical center + 4 community hospitals 2+ years as learning collaborative Formed new entity in June 2014 to develop clinically integrated network
- 29.
- 30. Page 30 NetworkCompacts 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
- 31. Page 31 MemberContracts 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
- 32. Page 32 MDAnderson, Mayo, Cleveland Clinic • Franchise reputation – Control vs. collaboration • Disease specific (cancer, heart) • Continuum of care? • Reach out to rural?
- 33. Kansas Heart andStroke 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 Page 33 heart attack or stroke
- 34. The Kansas Heartand Stroke Collaborative is a care delivery and payment model to improve rural Kansans’ heart health and stroke outcomes and reduce total cost of Page 34 care for that population.
- 35. Page 35 OverarchingStrategies Integration (Teamwork) Interventions Incentives (Rewards for Teamwork + Fieldwork) (Fieldwork)
- 36. Page 36 Universityof Colorado Health • Defensive move against national systems – Centura, Health One, Sisters of Charity Leavenworth • Focus on efficiencies • Prestige of AMC association (research and education) • Looking for like-minded partners
- 37. Page 37 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
- 38. Page 38 Committo Action • Shared vision • Balance interests (common vs. individual) • Committed resources – Time and energy – Financial • Accountability • Trusting environment
- 39. Page 39 SSOC/CSOCPhases 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
- 40. Page 40 SSOC/CSOCPhases 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 Exit Strategy • Specify triggers • Determine procedures to wind down alliance
- 41. Page 41 HowStructure 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
- 42. Key Elements ofan Effective Structure Page 42 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
- 43. Martie Ross mross@pyapc.com Jeff Ellis jellis@pyapc.com Pershing Yoakley & Associates, PC 9900 W. 109th Street, Suite 130 Overland Park, KS 66210 913.232.5145 Prepared for University of Missouri Health System November 15, 2013 Page 43