Healthcare leaders, discouraged by the failure of competition to control costs and improve care outcomes, are turning to collaborative models to enable them to serve their communities. At the heart of the healthcare reform proposals of the Catholic Health Association and other organizations are networks of providers that provide a continuum of services. Two successful models of collaboration—one that improves the efficiency of the delivery of cardiology services and one that integrates chronic care services—were explored at a forum sponsored by St. Paul-based InterHealth last fall.
Cardiology Consortium
The Rocky Mountain Heart Consortium, Denver, comprises 14 hospitals that offer open heart surgery services (see "Hospitals in the Rocky Mountain Heart Consortium" at the end of this article), as well as physicians and community leaders. It was organized by the Rocky Mountain Heart Research Institute, Denver (which recently merged with the consortium), to design a regional cardiac care delivery system through collaborative planning. The goal was to provide less duplicative, higher-quality services, said Ann Fenton, the consortium's executive director.
Consortium Activities The consortium, which resulted from a planning process begun in January 1991, has developed five programs:
- Services for the medically indigent. In a six-month pilot program, started in January 1993, seven Denver hospitals, along with cardiologists and cardiovascular surgeons, are providing care to indigent patients.
- Educational conferences for physicians, nurses, and technicians on issues ranging from cardiac imaging to ethics in cardiology.
- Technology evaluation. Fenton said that, as a result of research by the consortium's technology planning committee, five hospitals abandoned plans to purchase separate positron emission tomography (PET) scanners, eliminating costly duplication.
- Data. The consortium's Research and Data Center is developing a uniform cardiology data base to enable consortium participants to study services' outcomes and cost-effectiveness. The consortium will use the data with physician study groups to change behavior, Fenton said.
- Clinical research. The consortium is able to attract major cardiovascular research projects, Fenton said, because of the large number of patients available through its members. For example, the consortium will participate in a four-year study of the efficacy of Coumadin and aspirin in preventing second heart attacks. In addition, the consortium is forming a central institutional review board that will review protocols to be implemented at multiple sites. A research committee will set research priorities and criteria for protocol review and acceptance.
Getting Started Six hospitals originally joined the consortium, contributing $20,000 each. It was difficult, Fenton said, to convince hospitals that the organization would help them, and they needed time to understand each other's culture and philosophy. The consortium has held a series of retreats for representatives of providers and managed care and consortium board members. Participants focused on defining an ideal cardiology system and developing standards of excellence.
Consortium Organization The Strategic Planning Committee, made up of the hospital chief executive officers and physicians, makes recommendations to the consortium's board of directors. The board is made up of community leaders from business, industry, and government, as well as two hospital representatives.
Consortium teams on indigent care, professional education, technology, data, and clinical research report to the Strategic Planning Committee. Team members come from a variety of areas, Fenton said. For example, a person from state government works on the indigent care team.
Future Needs The consortium's members are taking small steps toward eliminating duplicative services, Fenton said. "These areas are very hard because they involve egos and the bottom line," she remarked, but she said the consortium has succeeded because it has involved the right people in the community and has worked through win-win strategies. In 1993 the consortium will continue to focus on statewide cooperative planning.
Chronic Care Consortium
The National Chronic Care Consortium (NCCC), Bloomington, MN, is the catalyst for local geriatric care networks (GCNs) that are being set up across the country (see "Members of National Chronic Care Consortium" at the end of this article). NCCC was established in 1991 by Altcare, a partnership between General Mills and the Wilder Foundation, to develop new methods of care for the frail elderly. Its 20 members, chosen for their leadership in healthcare innovation, are forming GCNs that will provide an integrated continuum of preventive, acute, transitional, and long-term care services. All will operate under common care protocols and quality measures.
The GCNs will offer specialized short-term services, including geriatric assessment, inpatient transitional care, geriatric rehabilitation, adult day healthcare, home health services, and care giver support services. The networks will use simplified procedures that allow clients access to all services from any point of contact within the network.
Care management, coordinated with primary care physicians, will be an attribute of all GCNs, Browne said. The GCNs will also offer patient education and training and self-help assistance, including technologies that allow clients to maintain their independence. Each GCN will have organizational capabilities such as strategic planning; financial management to link reimbursement with outcomes; information management to provide decision makers with common client, clinical, and financial data; quality assurance; and marketing. Each will offer managed care for chronic care clients.
One System's GCN
When it joined the NCCC in January 1991, Lutheran General HealthSystem (LGHS), Park Ridge, IL, was already offering a wide continuum of services for the elderly. In addition to acute and long-term care, LGHS provided many community- and church-based services, housing, and a substance abuse program. However, the services were not integrated and people sometimes "fell through the cracks," according to Ellen Browne, who described the system's participation in the consortium. Browne, who is vice president of Aging Services, Parkside Senior Services, Park Ridge, said the system needed cooperation and internal communication mechanisms to ensure patients had access to all programs across the spectrum.
"When I was assigned to lead Lutheran General in implementing the goals of the consortium, I knew I had to do things differently," she said. "If we were to be successful at LGHS, we needed key people collaborating on the goals." The solution was to form committees "with very specific goals based on the attributes required for a GCN," Browne explained. Now 80 staff people from LGHS entities, as well as providers and community members, serve on 11 committees.
The committees, which meet every four to six weeks, coordinate activities in many areas, including finance, marketing, education, wellness, information systems, and research. The marketing committee, for example, eliminated separate brochures for each program and produced one brochure for all aging services in the system, Browne said. The education committee is creating training programs aimed at teaching employees to work effectively with older adults and instilling positive attitudes toward aging. The networking committee integrates external service providers into the GCN. And the central access/intake committee eliminates duplication in assessment.
Successful Cooperation "A spirit of collaboration" is integral to establishing a successful GCN, Browne said. "It is difficult for hospitals to treat others as equals," she said, but they must collaborate with consortium members and with outside providers. Also, all persons who work with older adults—no matter what hospital department they are part of—must function as part of a team to serve the chronically ill, she said.
"As we endeavor to reform the way services are financed, administered, and delivered to the chronically impaired elderly, we are asking people to plan and to eventually make some major changes in the way they operate on a day-to-day basis," Browne pointed out. She said that Lutheran General continues to incorporate into its daily operations the critical elements of successful internal and external collaboration. These include encouraging employees to work not only within the system but also with community players, ensuring that all stakeholders benefit from the arrangement, identifying effective processes and expected outcomes by allowing all players to speak freely about what they need to do their jobs, and evaluating processes to ensure accountability to the community.
—Judy Cassidy
HOSPITALS IN THE ROCKY MOUNTAIN HEART CONSORTIUM
Denver
The Children's Hospital
Lutheran Medical Center
Mercy Medical Center
Porter Memorial Hospital
Presbyterian/St. Luke's Medical Center
Rose Medical Center
St. Anthony Central
Swedish Medical Center
University Hospital
Boulder
Boulder Community Hospital
Grand Junction
St. Mary's Hospital and Medical Center
Fort Collins
Poudre Valley Hospital
Colorado Springs
Memorial Hospital
Penrose Hospital
For more information, contact Rocky Mountain Heart Consortium, 1601 Milwaukee St., No. 626, Denver, CO 80206, 303-393-3951.
MEMBERS OF NATIONAL CHRONIC CARE CONSORTIUM
Amherst H. Wilder Foundation/HealthEast, St. Paul
Baylor University Medical Center, Dallas
Benjamin Rose Institute/University Hospitals of Cleveland, Cleveland
Beth Abraham Hospital, Bronx, NY
Beverly Hospital, Beverly, MA
Carondelet St. Mary's Hospital and Health Center, Tucson, AZ
The Eddy, Troy/Albany, NY
Fairview Hospital and Healthcare Services/The Ebenezer Society, Minneapolis
Group Health Cooperative of Puget Sound, Seattle
Henry Ford Health System, Detroit
Huntington Memorial Hospital, Pasadena, CA
Intermountain Health Care, Salt Lake City
Lutheran General HealthSystem, Park Ridge, IL
Lutheran Health Systems, Mesa, AZ
Mount Zion Health Systems, San Francisco
Philadelphia Geriatric Center/Albert Einstein Medical Center, Philadelphia
Provenant Health Partners, Denver
Rochester General Hospital/Park Ridge Health Systems, Rochester, NY
St. Mary Medical Center, Long Beach, CA
Sutter Health, Sacramento, CA
For more information, contact NCCC, 5001 W. 80th St., Suite 449, Bloomington, MN 55437, 612-835-1915.