CONSORTIUM MODEL NETWORKS

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1 JULY 2015 CONSORTIUM MODEL NETWORKS EVALUATING THE POTENTIAL OF COLLABORATION

2 About The Chartis Group The Chartis Group is a national advisory services firm that provides strategic planning, accountable care, clinical transformation and information technology consulting services to the country s leading healthcare providers. The firm is comprised of uniquely experienced senior healthcare professionals and consultants who apply a distinctive knowledge of healthcare economics, markets, clinical models and technology to help clients achieve unequaled results. Contact the authors for more information or discussion about this report: Greg Maddrey Director gmaddrey@chartis.com Anneliese Gerland Accountable Care Solutions agerland@chartis.com Practice Manager Cindy Lee Principal clee@chartis.com Gene Corapi Principal gcorapi@chartis.com For more information about The Chartis Group, please visit our website at or contact: Amy O Brien Vice President, Strategic Growth aobrien@chartis.com

3 Consortium Model Networks: Evaluating the Potential of Collaboration by Greg Maddrey, Anneliese Gerland, Cindy Lee and Gene Corapi Economic pressures and the shift towards value-based reimbursement are motivating providers to form larger, more comprehensive delivery networks. Consolidation through merger and acquisition and physician employment continues to be pervasive. At the same time, many providers are stopping short of full organizational integration or employment in favor of clinical integration, joint risk contracting or other shared pursuits. Initially, these arrangements were most often formed by a single health system to improve alignment with its employed and independent physicians. More recently, consortium model networks have emerged that involve multiple health systems, along with their aligned physicians, joining forces to explore collaborative endeavors, often with a primary focus on better positioning for value-based care and payment models. The underlying tenet of consortium networks is that together, organizations can achieve greater benefit than they can easily achieve independently. The real test and challenge for consortia is to translate this conceptual premise into actual results. While many consortia hold great promise, the complexity of navigating amongst differing cultures, leaders and objectives as well as anti-trust and other legal considerations pose significant challenges so consortia should not be entered into lightly. Over the past several years, many consortia have formed to increase their coverage across a broader geography to access and serve a large population in order to both attract health care purchasers and better enable providers to demonstrate value by managing a broad base of lives. Consortia aim to serve a large metropolitan area or much broader geographies that span multiple regions across the state or, in some cases, multiple states (see Figure 1 on page 2). It is too early to tell whether most of the consortia already in place or being assembled can be sustained. Some health system executives participating in these consortia have indicated these arrangements represent an important transitional model that may lead to fuller integration among some or all of the participants, while others explicitly state they have no intention to pursue full integration. 1

4 FIG. 1 Single region / multi-region consortia by date of announcement S I N G L E R E G I O N Nebraska Health Network (Greater Omaha) Northwest Metro Alliance (Minneapolis/St. Paul) Arizona Care Network (Greater Phoenix) Georgia Health Collaborative (Greater Atlanta) Noble Health Alliance (Greater Philadelphia) Healthcare Solutions Network (Greater Cincinnati) Anthem Blue Cross Vivity (Los Angeles and Orange Counties) Bay Area Accountable Care Network (Bay Area) Pre Integrated Health Network of Wisconsin (WI) (formerly Quality Health Solutions) University of Iowa Health Alliance (IA) Texas Care Alliance (TX) AllSpire (NJ, NY, MD, PA) Together Health Network (MI) Value Care Alliance (CT) Health Innovations Ohio (OH) abouthealth (WI) Midwest Health Collaborative (OH) Advanced Health Collaborative (MD) MPact Health (MO) M U L T I - R E G I O N / S T A T E W I D E Despite the short history of consortia development, we can draw on several lessons learned from our experience assembling, designing and launching several of these entities and from discussions with leadership of other consortia. Health systems considering forming or participating in consortium models should carefully consider three key issues to determine whether and how consortium development and participation may be right for their organizations. Lesson 1: Consortia Must Define Specific and Meaningful Goals The first step for any consortia is foundational they need to define specifically what products or services the consortium will develop and the benefits they expect to gain through the collaboration. The consortium s goals and activities should be greater than what any of its individual entities could achieve on their own to warrant the work required to come together. Some organizations assume there is intrinsic value in combined scale and expertise, without articulating or testing what that really means. Very early in the planning process, consortia should define specifically what they plan to do together, when, with whom, and how they plan to engage with one another both within their own organizations and within their local clinically integrated networks (CIN). Most consortia assemble with two principle longer-term goals in mind: 1. Develop joint network products: coordinated pursuit of direct-to-employer offerings or payor products with shared accountability, typically enabled by either clinical or financial integration; and 2. Build shared population health management capabilities: joint development of central services and infrastructure to support emerging value-based payment models, to be used by each of the members and possibly to be commercialized and sold to others. 2

5 While consortia often share these ambitious long-range objectives at the outset, they may begin with more modest forms of collaboration such as clinical best practice knowledge sharing, supply chain management or joint investment in non-patient facing support services. These early collaborative opportunities provide relatively low-risk avenues to build trust while achieving some immediate benefits such as cost savings. However, these efforts alone are typically insufficient to motivate and maintain member engagement over time, and the benefits of these activities often do not outweigh the investment of resources, time and energy required to maintain collaboration. Consortia must move beyond these efforts toward more meaningful goals of creating joint value-based offerings and products and developing shared population health infrastructure to keep participants engaged, drive shared accountability and deliver significant results. While numerous consortia have formed in the past several years, many have not yet launched these more involved efforts, or have done so with limited success beyond very narrow populations, such as Medicare Advantage. As in all strategic planning efforts, consortia must define tangible goals and objectives for what they intend to do together, with the particular added challenge of navigating how such shared objectives and associated activities may complement or in some cases contradict individual, local efforts. Consortia-related efforts will require significant effort and time to plan, gain approvals and execute. Some key questions to consider include: What populations are we seeking to serve? What infrastructure must we build to manage the health of this population? What services will be provided centrally by the consortium and what will be the responsibilities of each local delivery system? Consortia leadership must wrestle with these questions and develop a shared understanding of their objectives and how those translate into specific strategies and tactics. Given anti-trust requirements, participants must focus their discussions on pro-competitive goals and not reveal sensitive information that could restrict competition. Yet, as appropriate, participants should assess what these joint pursuits may mean for other individual efforts. Defining the Consortium s Goals: What do the participating health systems/networks believe to be the value of the consortium? What do they believe can be better accomplished together than on their own? Given individual system strategies and activities, what specific activities will be pursued through the consortium? What activities are off the table? How will joint and local activities be coordinated and aligned? 3

6 Lesson 2: Consortia Must Confirm That the Opportunity and Potential Incremental Value for Each Participant Warrants the Joint Effort The second essential step for consortia is to validate the market opportunity and demand for the offerings they plan to pursue a network product or shared population health management capabilities. This will help determine if there is sufficient benefit for the consortium as well as for each participating health system. Network Product Go-to-Market: Consortia must identify whether there is a target market segment and product(s) that they could successfully bring to market that will provide sufficient strategic and economic benefit to the individual consortium participants. Traditional market segmentation assessments consider populations by payor segment (e.g., commercial, Medicare, Medicaid, self-pay), group size (e.g., individual, small group, large group) and carrier (e.g., Aetna, Blue Cross Blue Shield). However, consortia need to go a step further and segment the purchaser market at a more granular level to test the premise that they can offer a product that meets the needs of the end purchaser specific employers, government agencies, and increasingly, individual marketplaces given the network coverage area and value proposition of the participating health system members. Consortia should consider the size and distribution of the members / employees of these potential purchaser segments and associated purchasing characteristics to determine which market segments to prioritize and the unique value proposition required to transition lives from existing products to the new consortia products. Figure 2 provides a sample list of segments and questions that should be addressed for each segment to understand their key buying characteristics. FIG. 2 Sample approach to targeting purchaser segments PURCHASER SEGMENTS Who are the different buyers of insurance products? 1. Commercial Group a. National Sited b. National Non-Sited c. State Multi-Site d. State Single Site e. Public Sector f. Taft-Hartley Groups g. Federal Employees 2. Medicaid a. Managed Medicaid b. Dual Eligible 3. Medicare a. Medicare Advantage Individual b. Medicare Advantage Group 4. Individual BUYING CHARACTERISTICS What are the key factors that influence their purchasing decisions? 1. Pricing: How price sensitive are the purchasers? 2. Product Design / Choice: How wide does the range of benefit offerings (basic to rich) need to be? 3. Member Experience: How sensitive is the segment to customer service and experience? How demanding are the service standards required? 4. Quality: How important is the brand reputation in the buying decision? 5. Administrative Simplicity: Does the segment prefer bundled or customized benefits? Do they value integrated product offerings? EVALUATION CRITERIA Does the segment meet consortium member criteria? Does the Consortium fit the needs of the purchaser segment? Does the segment represent an opportunity that supports each participant s strategic and economic imperatives? Potential Targeted Purchaser Segment Opportunities for Consortium 4

7 There are meaningful differences in the needs of each market segment; not just across the broad payor categories (commercial, Medicare, Medicaid), but also by employer type within the commercial segment. For example, smaller, single-state employers tend to be more price-sensitive and willing to be more flexible in benefits design. National employers are often more demanding, have specific goals and needs, and utilize benefits consultants and brokers to advise them in designing products that best meet these goals. Convincing national employers to execute a different strategy for one market may be challenging and complicated to navigate. In addition, the distribution of lives relative to the consortium s coverage area and relative to the overall employee base will be critical to understand. For example, a national employer with only a small fraction of its total workforce in one state or region may consider it a hassle to offer a unique product to that region alone, or alternately, could consider it a good test market for a value-based product given the relatively small impact it would have. Meanwhile, a large state-based employer with a concentration of employees in a single metropolitan area may not be very interested in a statewide network. Understanding the potential size of each of these purchaser segments and the geographic distribution of lives in relationship to the consortium s service area is a critical requirement to understand the potential relevance and attractiveness of a potential consortium product for a purchaser. Hypothesizing the specific purchaser s perspective and creating a specific strategy for pursuit will be critical. Once high priority target segments have been confirmed, consortia need to identify how a jointly developed product provides its delivery systems and provider participants with greater impact than they could achieve alone. In some cases, organizations may believe there could be demand for a product offered by a consortium but that those segments are already well-served by the individual organizations. Participants may find that the consortium s potential products provide significant benefit for some but not for all equally. In some cases, the market demand for consortium products may be rather limited suggesting that the opportunity may not justify the work required to pursue a joint approach. In addition, consortia must understand the comprehensive requirements for bringing a product to market and the desired channel(s) for pursuit i.e., direct to employer, in partnership with payors, via private exchanges, or via public exchanges. The evaluation of these channel options should include careful consideration for how the consortium s go-to-market approach may disrupt existing relationships with payors and employers. For example, choosing a preferred payor partner or pursuing direct to employer contracts may strain participants existing relationships with payors. This evaluation of options could become more complicated if any of the member health systems own a health plan or are already participating in meaningful value-based initiatives with payors or employers that the consortia intends to pursue. Shared Population Health Management Capabilities: Consortia will require a shared operating model with central capabilities and services to support the successful planning, launch, and performance management of value-based products, such as 5

8 network and utilization management. Some consortia are choosing to utilize the existing capabilities of one or more of the participants, whereas others are building such capabilities together. Given the investments required to build and scale population health management capabilities, consortia should also explore whether developing all or parts of these services centrally will benefit participating health systems and physicians and their respective local product portfolios. Scaling these shared population health capabilities beyond the consortium s own network products to support individual participants value-based products would also provide a larger base to spread investments, leverage economies of knowledge and experience, and most importantly, create a single service model and data set for the end-users to access. Consortia may also consider the potential to commercialize specific services to extend outside the collaborative. The opportunities identified may not represent net new services or investments for all participants. In those cases, organizations should consider whether pursuing services jointly will result in a better outcome than pursuing services alone by enhancing the potential impact, speed or efficiency. In some instances, enough members may have advanced their own population health management services and infrastructure that switching to a joint service would be overly disruptive. When this occurs, consortia will need to decide how to develop a shared experience across these disparate platforms by utilizing common approaches. In other instances, one organization may have developed more mature services that could be utilized as the platform to be scaled and shared with other consortium members. Ultimately, participating health systems and physician entities will need to make tough choices about what services should be developed and delivered centrally versus locally; in some cases departing from local efforts based largely on a belief, rather than solid economic proof, that pursuing a solution together is better than pursuing it individually. Legal considerations must also be addressed as meeting the standards for either clinical or financial integration will require some shared infrastructure and/or shared financial risk among consortium participants. Confirming the True Opportunity: Of a joint network product offering: What are the purchaser segments to which this network is most appealing and what is the potential size and distribution of this market segment? How are these segments served today (carriers, product types)? What would be required to take a product to market? What will be the competitive response from other payors or providers? What other challenges might the consortium face? Of joint development of population health management capabilities: What services are required to support the network product? Could these services benefit individual members locally as well as the network? Are there any services that may be commercialized beyond the network s members? What would be the demand for these services? 6

9 Lesson 3: Alignment Is the Most Critical and Hardest Requirement for Creating and Maintaining Consortia Achieving and sustaining meaningful alignment between multiple key leaders and other stakeholders is required to successfully develop consortia. Reaching a go / no go decision will require members to tackle the difficult questions of: how the joint efforts could impact the strategies and economics of individual participating systems, and; how decisions will be made together to optimize the whole while also understanding the implications of these decisions on each participating system. Once the joint entity is formed, leaders from each member organization must engage their key physicians, care managers, population health staff and other stakeholders to deliver on the consortium s promise. Figure 3 describes the dimensions and constituencies across which alignment must be achieved: FIG. 3 A Multi-Layer Approach to Achieving Alignment Strategic Employed and Independent Physicians Economic Clinical and Administrative Leadership and Staff CONSORTIUM ALIGNMENT Governance Owned Acute Care and Other Clinical Services Academic Assets and s A Collective Mission and Vision Trusting and Productive Relationships Clinical s Management Each consortium will need to align how strategic, policy and operational decisions will be made and managed and how consortium economics will be handled, including investments and incentive distributions related to network products. These decisions will need to be aligned across consortium members at the highest level as well as within each local system and its associated network in order to be internally consistent and mutually reinforcing. Consortium leaders often agree on goals, approach and direction without fully engaging their local organization s full leadership team, leaving them at risk of not fully understanding the implications of their decisions. Aligning local leaders, operators and clinicians around the consortium s rationale and objectives is critical to avoiding conflicts and minimizing potential 7

10 confusion that may arise later. Investing the time up front to gain alignment across not only the leadership involved in consortium planning, but also the local leadership of each member will allow the consortium to move more quickly in the long run. Achieving Alignment: Do the leaders understand what each has to contribute to make the consortium viable: e.g., leadership / resources? How will the consortium s members each drive engagement and alignment with their respective key stakeholders, e.g., physicians and clinical staff, leadership, community partners? Implications Consortia present an exciting opportunity for innovation in healthcare given the broad populations they could serve and the alignment that could be achieved without a full merger. At the same time, the inherent complexities of melding multiple organizational cultures create a high risk of failure without aligned goals, defined pursuits, realistic expectations of results and timelines and an aligned operating model across the participating members. Most critically, consortia participants will need to grapple with the implications of joint initiatives on their individual member system strategies. For health systems considering collaborative pursuits, it is critical to address these difficult questions and topics before investing significant time and capital. Organizations must be transparent and open early in the process so that go / no go decisions made by each member are based on the complete picture. Consortium participants also will need to learn to debate and fight well, without allowing their differences to take over. Ultimately, there is a balancing act for members to remain cautious yet focused on the collaboration s true potential and goals. There will always be reasons not to follow through with a new partnership, but if there is a meaningful opportunity, members should be willing to work together through the challenges that will invariably arise along the way. Importantly, these imperatives are not limited to the planning phase of a consortium. The real work begins when organizations define and confirm the value proposition and the new entity is launched. Staying power will require continuous reflection and reaffirmation that the benefits of collaboration are greater than what individual members can accomplish on their own. 8

11 Boston 29 Commonwealth Ave 10th Floor Boston, MA Chicago 220 West Kinzie Street Third Floor Chicago, IL New York 120 East 23rd Street Fifth Floor New York, NY San Francisco 1 Market Street 36th Floor San Francisco, CA The Chartis Group, LLC. All rights reserved. This content draws on the research and experience of Chartis consultants and other sources. It is for general information purposes only and should not be used as a substitute for consultation with professional advisors.

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