Leaders say partnership helps prepare them for reform
By JULIE MINDA
Two Catholic health care providers are among the four Iowa health systems that have formed an alliance aimed at better coordinating how care is provided, improving care quality and safety, making health care delivery more efficient and reducing costs. Leaders of the organizations involved in the alliance, announced this summer, said their efforts are helping them ready for a post-reform environment.
Under health care reform, "as organizations assume more risk, we'll do a better job if we have scale," and regional partnerships are a way to achieve that scale, said David Vellinga, president and chief executive of alliance member Mercy Health Network of Iowa, based in Des Moines.
As the U.S. health care system changes, "you can't just dabble in (the changes) — you have to be all in. You need to ensure you can survive and thrive economically," said Vellinga, who also is president and chief executive of Mercy Health Network's Mercy Medical Center – Des Moines and holds executive titles with Novi, Mich.'s Trinity Health and Englewood, Colo.'s Catholic Health Initiatives. Trinity and CHI oversee Mercy Health Network through a joint operating agreement. Mercy Medical Center – Des Moines is owned by Catholic Health Initiatives.
A loose affiliation
The Iowa partnership called the University of Iowa Health Alliance includes Mercy Health Network with its 11 owned and 27 affiliated hospitals, Genesis Health System of Davenport with its six owned or affiliated hospitals (two of which are in Illinois), the one-hospital Mercy – Cedar Rapids and the one-hospital University of Iowa Health Care. Each of the four partners also has an extensive network of outpatient facilities.
The alliance currently is structured as a loose affiliation in which top executives and their representatives agree on the goals and initiatives they will pursue and then engage their administrative and clinical staffs in projects to further those goals.
A top goal is for the systems' staffs to work together to improve primary and preventive care by ensuring Iowans have access to medical homes, including by making sure there are sufficient primary care services available. The systems also are sharing clinical best practices with one another to ensure they are delivering care as effectively as possible. They are improving how patients move through the health system, in part by increasing the use of health coaches who can ease patient transitions and improve patient compliance with clinician instructions.
The systems also are standardizing how they collect and report health data for their patients. They measure their success using metrics established by the Centers for Medicare and Medicaid Services. They share ideas on how to manage population health.
Within several years, the four plan to forge a single accountable care organization, as defined by the Centers for Medicare and Medicaid Services. Currently, Mercy Des Moines and Genesis each has its own accountable care organization; and Mercy – Cedar Rapids and the University of Iowa system participate together in a separate ACO. The plan is to combine these three ACOs into one.
The alliance members do not plan to integrate their assets, including under the ACO structure.
Evolving incentives
John DiCola is CHI senior vice president, strategy and business development. He said, "Providers need more coordinated care models and value-based (models). They need to begin to think of serving populations and managing population health — but with more quality and less cost. They need new capabilities to understand risk." He said that the activities of the alliance move the Iowa providers in this direction.
Timothy Charles is president and chief executive of Mercy – Cedar Rapids. He said the focus areas of the alliance are in part "a function of some of the incentives embedded in how we're thinking about health care reimbursement," particularly since reimbursement increasingly will be tied in with population health management and quality goals under the Patient Protection and Affordable Care Act.
CHI's DiCola said that health care providers, payers and consumers all are recognizing that the current fee-for-service model is not sustainable, and many believe that a model that rewards providers for health improvements achieved for populations of people makes more sense.
DiCola said that establishing statewide provider alliances and networks helps to create delivery system scale and broader access that the providers need to accept risk sharing contracts and to interact successfully with the insurers who will participate in Iowa's insurance exchange, or provide managed Medicare or Medicaid products.
Charles said responding to the trends in the federal, state and private payer realms as a smaller, independent system would be difficult for Mercy – Cedar Rapids because it takes significant financial and staff resources to build up the clinical expertise, information technology systems and data warehouses, and other infrastructure needed to manage population health.
The alliance "allows us to develop the appropriate scale and expertise without jeopardizing our independence, our Catholic identity and our commitment to provide services to our community," he said.
Vellinga added that the Iowa providers' alliance's focus on coordinated care, preventive care and community health, intersects with the Catholic health mission in a better way than fee-for-service medicine. "We are dedicated to serving the health needs of our communities," and the alliance will help advance that effort.
For CHI partnerships, 'structure follows strategy'
In addition to the Iowa partnership, Catholic Health Initiatives of Englewood, Colo., is involved in a wide variety of affiliations and joint operating arrangements and has more in the offing.
They include:
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Englewood-based Centura Health, a joint operating agreement between CHI and Adventist Health System
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KentuckyOne Health of Louisville, Ky., a merged subsystem with CHI facilities and Jewish Hospital HealthCare Services facilities
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Cincinnati's TriHealth, a joint operating arrangement of CHI's Good Samaritan Hospital and a system called Bethesda
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A planned integration of the Northwest U.S. facilities of CHI and PeaceHealth of Vancouver, Wash.
CHI's John DiCola, senior vice president of strategy and business development, said each arrangement is tailored to the particular goals of the partners involved and the time in which the arrangement was formed (most of these CHI partnerships were formed well before the passage of health care reform). "Structure follows strategy," he explained.
He noted that most of the CHI arrangements that involve the integration of assets, are with organizations with missions, visions and values that are very similar to those of CHI. Under health reform, there are more incentives to take a broader view of partnerships and to consider alignment with different organizations, such as secular facilities, academic organizations and for-profit facilities. Alliances like the University of Iowa Health Alliance lend themselves to partnerships of dissimilar organizations because they do not involve the complexity of merging assets.
DiCola said, "Partnerships like these give us the opportunity to be more effective because we can broaden our reach with those with a similar commitment," albeit a different operating structure.
On Nov. 1, CHI assumed full ownership of Omaha, Neb.-based Alegent Creighton Health, which had been a joint operating company involving CHI, Creighton Health and Immanuel health and senior services.
Copyright © 2012 by the Catholic Health Association of the United States
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