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BY: PATRICIA A. MARYLAND, DrPH

Two are better than one, because they have a good reward for their toil. For if they fall, one will lift up the other; but woe to one who is alone and falls and does not have another to help.

— Ecclesiastes 4:9-10

Art Valero

The whole is often greater than the sum of its parts. This concept is certainly true of successful health care partnerships today that enable each partner to be more than it could be alone. Ascension increasingly relies on such partnerships and collaborations to bring greater value to those it serves.

With its sizable national footprint and broad scope of services and subsidiaries, St. Louis-based Ascension historically has developed relationships with Catholic and other-than-Catholic organizations alike. Physicians, third-party payers and other health care providers offer services across the care continuum that may not otherwise be available through our local facilities.

As we develop these valuable partnerships, we continually strive to maintain the Catholic identity so central to our past, present and future while finding ways to expand access to compassionate, personalized care in the communities we serve.

WHY PARTNER?
Collaborative business relationships with physician groups and other health care entities are one way to strengthen our capacity to serve while ensuring both ministry and financial sustainability. Ascension's "Quadruple Aim" calls us to deliver improved health outcomes and enhanced patient and provider experiences at a lower cost of care. To reach these goals, our strategy involves developing regional clinically integrated systems of care throughout our ministry reach, which covers 23 states plus the District of Columbia.

Entering into key partnerships better positions us to deliver on that promise in a variety of ways:

Expanded regional coverage. Providing access to quality health care across a broad geography is at the core of our approach. Partnerships help provide a presence that enables more points of access to those we serve, particularly during a time and within a business environment in which narrow networks are becoming increasingly popular as a way to keep costs down.

Economies of scale. Providing health care is a costly endeavor. By merging or collaborating with other health care entities, partners gain greater purchasing power, negotiating for lower costs on equipment and supplies as a result of the greater volume needed. Paying lower costs while maintaining the same or a higher level of quality allows us to focus assets toward providing compassionate, personalized care to individuals in the communities we serve.

Data. As U.S. health care transitions from a hospital focus to a population health focus, access to real-time data across the entire care continuum plays a vital role. Partnering with other health care entities can give providers greater access to clinical data, which then translates into improved care coordination, more integrated services and a reduction of waste and duplication.

Intellectual capital. Partnerships and mergers offer opportunities for enhanced thought leadership, research and physician alignment. It is difficult to quantify the full impact that sharing valuable insights can have. Whether it's determining the best practice strategy to tackle sepsis or finding a new approach to supply chain processes, sharing intellectual capital is mutually beneficial.

Bear witness. According to the United States Conference of Catholic Bishops, forming new partnerships can be an opportunity for Catholic health care institutions to "witness to their religious and ethical commitments and so influence the healing profession."¹ As we incorporate Catholic social teaching and care for those who are poor and vulnerable into the cultures of new partners, we extend our Catholic identity into more communities.

DISCERNMENT
Discernment ultimately boils down to aligning our mission, vision and values within the relationships we seek to develop. Therefore, each opportunity to expand — whether through a joint venture, acquisition or merger — involves an evaluation intended to ensure that the relationship supports our Catholic values and commitments.

When there are several uncertain paths to choose from, or the decision will have an impact on multiple dimensions of Ascension and its operations and culture, we employ a nine-step organizational ethics discernment process. Often, however, we are able to use a less extensive process that contains some of the same elements by employing such tools as our ethics and values compatibility assessment, Catholic identity assessment and cultural assessment. All these help us ensure alignment with our ministry values.

PARTNERSHIPS
Meet some of Ascension's partners:

AMITA Health — AMITA Health is a joint operating company formed in February 2015 by Alexian Brothers Health System, part of Ascension, and Adventist Midwest Health, part of Adventist Health System. Together, the nine hospitals, 3,000-physician provider network and related services provide care in the western suburban Chicago area.

AMITA Health already has realized several benefits thanks to their partnership.

"We have been able to take the best of both organizations and share it with the other and have already noted improved outcomes in regard to sepsis rates, antibacterial stewardship and in reducing induced labor rates as a result of our partnership," said Mark Frey, president and CEO of AMITA Health and former president/CEO of Alexian Brothers Health System. "We are also finding significant opportunities to reduce expenses."

According to Frey, the partners' complementary mission, vision and values made for a smoother transition to a joint operating company.

"As we brought two different faith traditions together, we wanted to preserve the Catholic and Adventists faith traditions," Frey said. "We asked ourselves, 'What's the right structure that we can use to preserve religious identity? How will we treat our respective staffs and enhance the work they do? How do we keep this partnership consistent with the mission?'"

According to Frey, each of the two legacy organizations continues to have a vice president for mission integration who reports to the CEO. The vice presidents and CEO work together to ensure fidelity to the respective faith traditions and also to collaborate around issues such as integrating pastoral care services; maintaining mission, vision and values; and sharing information about commonalities and differences with leadership and the staff. Leadership functions celebrate the respective faith traditions of the partners.

Capella Healthcare — In 2012, Saint Thomas Health, an Ascension ministry based in Nashville, Tennessee, entered into a joint venture with Capella Healthcare of Franklin, Tennessee, to operate four rural Middle Tennessee hospitals that had been part of Capella. The goal was to expand services and access to specialists in the four communities served. In June 2015, that relationship evolved with the signing of a letter of intent for the four hospitals to become full members of Saint Thomas Health and Ascension.

When the joint venture began, "we were very excited to bring and extend the medical-centered home concept into these counties, and Capella was excited about being part of a faith-based organization. It was a win-win situation," said Mike Schatzlein, MD, senior vice president of Ascension Health/group ministry operating executive.

"Capella has always been a good partner," added Karen Springer, senior vice president of Ascension Health/Tennessee ministry market executive and president and CEO of Saint Thomas Health. "We developed a robust transition plan that made the first day, first week, first 30 days and so on go as smoothly as possible. We wanted to truly honor their associates for the good care and quality they continue to give their patients."

Thoroughly and effectively sharing with Capella associates what Catholic health care is all about has been an integral part of the ongoing transition process. For example, all Capella associates have gone through an orientation to Saint Thomas and Ascension, through which they were further immersed into the culture. In describing the orientation, Springer said, "It really sets the stage by showing what our founders did and what that means as an Ascension associate."

Crittenton Hospital Medical Center — In early 2015, Crittenton Hospital Medical Center in Rochester, Michigan, signed a letter of intent to become part of Ascension Michigan. Crittenton is a 290-bed acute care facility that serves Northern Oakland County.

"With the addition of Crittenton, we're able to strengthen our physician network and bridge the gap between two of Ascension's regionally integrated systems of care," said Gwen MacKenzie, senior vice president and Michigan market leader of Ascension Health. "We were pleased that they chose Ascension because of the cultural and quality alignment we share."

MissionPoint Health Partners — MissionPoint Health Partners began as an offshoot of Nashville, Tennessee-based Saint Thomas Health Network in 2011 in response to the growing need for population health management. Although most initial members consisted of Medicare fee-for service populations, MissionPoint has since expanded to nearly all populations in the health care system's service area — covering seven states and more than 250,000 members. Recognizing the results already realized in its three-year history — such as a 27 percent reduction in 30-day readmissions and a 22.5 percent decline in emergency room visits — Ascension brought in MissionPoint Health Partners as a direct subsidiary in 2015.

"MissionPoint is excited and humbled to continue our work with Ascension," said Jason Dinger, CEO of MissionPoint Health Partners. "I feel like this is just the tip of the iceberg when it comes to population health, and we look forward to learning more as we continue this relationship."

As a ministry-based, nonprofit organization, MissionPoint Health Partner's calling to better meet the needs of every member through reverent, holistic care echoes that of Ascension's. In fact, as a way to ensure the spiritual well-being of its members, MissionPoint Health Partners brought on chaplain Cathy Chang as a full member of the health care team last year. She has been able to help Nashville-based members through medical decisions as well as simply to provide the ministry of presence to members in their homes, in the hospital, or talking with them on the phone. This ministry speaks directly to Ascension's values of reverence and service to those who are struggling the most.

Together Health Network — Together Health Network began as a conversation between two Catholic health systems — Trinity Health and a number of Ascension Health ministries in Michigan that make up Ascension Michigan.

"We had such similar missions, values and culture that the partnership just made sense," said Scott Eathorne, MD, president and CEO of Together Health Network. "This became an opportunity for success in an ever-changing market."

The collaboration, which began in May 2014, has allowed both entities to combine their cost and quality performances into a statewide product that can provide personalized care and greater choices to the people and communities they serve.

The clinically integrated system of care, which spans nearly all of Michigan, consists of more than 5,000 physicians, 27 hospitals, and numerous outpatient centers (including skilled nursing and long-term care facilities, home health, palliative care services and hospice to ensure coverage across the care continuum). The partnership allows more than 75 percent of Michiganders — more than 7 million people — to be within 20 minutes of a Together Health Network provider.

OVERCOMING OBSTACLES
Successful partnerships involve a great deal of give-and-take in a relationship that requires foresight, preparation, sensitivity and respect. Despite best efforts, of course, obstacles can crop up at times because of cultural or operational differences, especially in the areas of human resources, information technology and ethics.

Ascension has found that these steps help with laying a firm foundation, identifying what the partners hold in common and acknowledging their differences during the transition into collaboration:

• Confirm the purpose
• Communicate goals and needs
• Maintain frequent visibility with boards
• Measure progress and outcomes
• Call out impediments to success
• Seek out mutually agreeable solutions

Here are some possible obstacles:

Human resources. Generally, arrangements with Catholic partners raise few human resources issues due to a common heritage and similar histories. For some joint ventures, however, creating one integrated organization from two disparate entities can pose challenges. AMITA Health was an example.

"We are working to create one HR team, one finance team, one clinical team and one communications team. It's not easy, but we're working through it by maintaining central objectives," Frey said. "Barriers occur simply because people are people, but our shared value system has significantly helped us through the process of integration."

Information technology. Interoperability is an amazing thing … when it works. Getting there is the most difficult part. Harnessing disparate systems and technologies can be an expensive challenge.

Getting an early start is important, advised Springer. "Ascension Information Services (AIS, the Ascension IT subsidiary) completed an assessment very early on in the process to work through potential barriers" in creating the Ascension-Capella joint venture, she said. Ascension is also a founding member of the national nonprofit Center for Medical Interoperability, working with other health systems to develop standards and certify devices that conform to them.

Ascension is committed to developing regional clinically integrated systems of care to better serve the needs of our communities. Partnerships have helped make this goal a reality, and our discernment process ensures a smooth transition that guarantees our rich Catholic tradition continues.

PATRICIA A. MARYLAND serves as president of health care operations and chief operating officer of Ascension Health, a subsidiary of Ascension, headquartered in St. Louis.

NOTE

1. United States Conference of Catholic Bishops, Ethical and Religious Directives for Catholic Health Care Services, 5th ed. (Washington, D.C.: USCCB, 2009), Part Six, Introduction.