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A small rural hospital wanted transform the way it delivers care to promote greater value and health outcomes and sought to build a clinically integrated network.


Background

The Hospital is a 116-bed hospital located in the Midwest. The Hospital, their employed physicians, as well as independent providers, formed a physician’s hospital organization (“PHO”). This was an important initiative for the organization for numerous years as it helped to bring together providers in the community and the Hospital. The PHO is a progressive organization and wanted to create a structure that promotes great value and health outcomes. In 2015, the PHO became the vehicle to build a clinically integrated network (“CIN”).

Our Approach

GEHC Camden Group was engaged by the PHO to develop the governance and legal structure of a CIN and help them operationalize themselves as a CIN.  The Board structure was created with a mix of hospital representatives and employed and independent providers representing numerous specialties. GEHC Camden Group spent time with the employed and independent providers to engage them in design of the CIN, respond to questions and provide general education.  By early 2016, 100% of the PHO became participating providers of the CIN.

Throughout 2016,  we assisted the PHO in developing the infrastructure to successfully manage the care of patient populations while focusing on reducing cost.  The physician-led governance of the organization developed policies to manage their members and establish standards for membership. As other local and regional facilities seek to join the CIN, the organization is developing criteria to evaluate new members. Through the Clinical Quality and Health Information Committee, the organization has selected a starter set of clinical programs and performance metrics that will be used to measure the provider membership and improve clinical delivery outcomes.

Further, we have assisted the CIN in creating a roadmap for their analytics solutions to aggregate data from the numerous EMRs that exist in their community.  With the increased visibility to the data, the organization will identify intervention strategies to improve the care and ultimately the health of their community.

As the CIN was emerging in the market, GEHC Camden Group  also worked with the Finance Committee to develop a core set of principles for negotiating value-based contracts.  These guiding principles have been foundational to setting the stage of payer negotiations.

In 2017, the Hospital  and CIN is committing to a contract to manage the Hospital’s employee and dependent population, and continue to look for payer partners who will support the organizational goals. We have also assisted the CIN and the hospital in developed a shared savings arrangement to manage the care of the Hospital’s self-funded plan.

Results

  • Clinically Integrated Network
    Facilitated design, development, and activation of a clinically integrated network, evolving from a PHO
  • Analytics Roadmap Created a roadmap for analytics solutions to aggregate data from EMRs that will enable the organization to identify intervention strategies to improve the care and health of their community
  • Shared Savings
    Developed a shared savings arrangement to manage the care of the Hospital’s self-funded plan

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