ENHANCE Health Network A brief overview. Michael S. Hein, President & CEO, ENHANCE Michael T. Hansen, CEO, Columbus Community Hospital

Transcription

1 ENHANCE Health Network A brief overview Michael S. Hein, President & CEO, ENHANCE Michael T. Hansen, CEO, Columbus Community Hospital 1

2 M&A Strategy Physician-hospital consolidation has not led to either improved quality or reduced costs. The Impact of Hospital Consolidation: Update, RWJF, June

3 ENHANCE Development Trigger Response Execution Forming Developing M&A consolidation of competitor into 13 hospital system 9 Nebraska systems announce plans for RPN, LLC RPN, LLC officially registered RPN, LLC stands up, grows organization, adds members & hires CEO Staffing, early wins, provider network development November 2012 October 2013 December 2013 Jan - December 2014 Jan - December

4 ship 66 members, 3 States 51 Critical Access Rural and Urban Academic & Community 3 Specialty Hospitals 2,500 providers & growing > $4.0 Billion Revenue 9 s 4

5 ENHANCE Health Network Mission and Vision MISSION Enhancing health in our communities by facilitating highquality, affordable care through education, innovation, and collaboration. VISION ENHANCE is an alliance of healthcare providers recognized as leaders in delivering patient-centered, valuebased healthcare through shared services and Clinical Integration. Support local autonomy and independence. Provide options for degree of involvement. Focus on innovating to create value. Provide access to care. Engage healthcare professionals. Embrace physician leadership. Collaborate with independent providers who choose to work together. GUIDING PRINCIPLES 5

6 Vision into 2016 Objectives 1) Create a high-performing network 2) Build business intelligence capabilities 3) Drive savings through Shared Services 4) Pursue and secure valuebased contracting 5) Develop medical management capabilities 6

7 Governance Board of Managers 20 members, 10 Votes (1 per dyad) Elected from 57 Affiliates Network ship Business Intelligence Clinical Leadership Shared Services Regional ship Payor Contracting and Finance Subcommittee Workgroups Subcommittee Workgroups Subcommittee Workgroups Subcommittee Workgroups Subcommittee Workgroups Subcommittee Workgroups 7

8 Basic Network Structure 8

9 Clinical Integration Micro-regions Micro-Reginal Integration Clinic Others Clinic CAH CAH Others CAH Clinic 9

10 Example: TCPI Grant Largest CMS grant ever. ENHANCE: 2300 providers, 100 practices, 3 States. Purpose: Prepare practices for a value-based world Grant used to employ QI assistants, data analyst, and create educational network Aligned organizational metrics to TCPI metrics Facilitator Transform practices Accelerator Resources acquisition Integrator Learning network 10

11 Example: Employee Health Plan 42,000 covered lives from 9 founding members EHP s Claims data from 4 TPA s into population health data analysis tool Structured, team-based, process improvement efforts Largest early win ROI opportunities Facilitator Data and team development Accelerator Regular support, advocacy Integrator Learning network of successes 11

12 Payor Strategy Re-cast the historical relationship Partner v. Competitor Umbrella upside-only contracts in effective Jan 1, 2016 Aligned metrics across all contracts, internally consistent A means to an end Shared Savings Quality Incentives PMPM 12

13 Shared Savings Activities 2015 Started: Price-leveling Blood products Cardiac rhythm Non-GPO regional products Complex TPA RFP Pharmacy distribution Group purchases Population health tool Some Lessons Learned Anti-trust precautions GPO relationships Broker relationships No co-terminus contracts Abundant opportunities Decision-rights challenges Positive organic spin-offs 13

14 Summary of 2015 achievements Clinical Integration Provider Network 2,300 CIN-based s 8 TCPI grant acquired Network quality standards Baseline assessment EHP PI projects in place 3 4 value-based contracts Shared Savings > $3,000,000 in annual savings Data analytic tool Review and execution process established 14

15 Closing Comments Accountable Communities for Health Network of independent, community-centered systems is a strength 15