Increasing Consolidation in Health Care a providers perspective

Increasing Consolidation in Health Care - a provider’s perspective 2016 Washington State of Reform Health Policy Conference Hiroshi Nakano Director | Value Based Care Hiroshi_Nakano@Valleymed. org

Why VMC and UW Medicine Affiliated 1. Increase access to healthcare services for South King County residents. 2. Improve efficiency of care; align best practice models expand clinical, teaching and research programs. 3. Position both organizations for future healthcare reform opportunities, such as the creation of an Accountable Care Organization (ACO). 4. Affiliation agreement signed in mid 2011.

UW Medicine|Valley Medical Center Structure 1. VMC assets remained district assets. 2. VMC continues to offer all core and clinical services. 3. UW Medicine offers additional clinical services in agreed upon service gaps. 4. VMC employed physicians and employees remain VMC employees. 5. District Board of Commissioners remains on the board. New board oversees VMC management. New board consists of: • 3 UW Medicine Designated Trustees • 5 Community Trustees • 5 Commissioner Trustees 6. Two VMC Commissioners sit on UW Medicine board.

UW Medicine Puget Sound Locations UW Medicine Shoreline Clinic UW Medicine Woodinville Clinic Northwest Hospital UW Medicine Residency Clinic Seattle Children’s UWMC Roosevelt UW Medicine Belltown Clinic Puget Sound Health Care System UW Medical Center Hall Health Primary Care Center Seattle Cancer UW Medicine Care Alliance Eastside Specialty Center Harborview Medical Center VMC and its … clinic network UW Medicine Factoria Clinic Airlift Northwest Renton Landing Clinic (Urgent Care & Sports Medicine) North Benson Clinic (Urgent Care) Cascade Clinic (Primary Care) Occupational Health Services UW Medicine Issaquah Clinic Newcastle Clinic (Primary & Urgent Care) Valley Medical Center Fairwood Clinic (Primary Care) Highlands Clinic (Primary Care) Valley Family Medicine Clinic (Primary Care & Residency Program) Kent Clinic (Primary & Specialty Care) UW Medicine Kent/Des Moines Clinic Covington Clinic North (Primary & Specialty Care) Covington Clinic South (Urgent & Specialty Care) Lake Sawyer Clinic (Primary Care) UW Medicine Federal Way Clinic Valley Women’s Healthcare (OB/GYN)

aco Networks in Puget Sound - Commercial UW Medicine ACO Network: Capital Medical Center Peace. Health UW Medical Center and clinics Cascade Valley Hospital and Clinics Seattle Cancer Care Alliance UW Neighborhood Clinics Island Hospital & Clinics Seattle Children's Hospital UW Physicians Multi. Care Connected Care Skagit Regional Health Valley Medical Center and clinics Overlake Medical Center Harborview Medical Center and clinics Proliance Surgeons Northwest Hospital & Medical Center and clinics Multiple physician practices Providence-Swedish Health Alliance: Providence Regional Medical Center Everett Swedish Ballard Proliance Surgeons Providence St. Peter Hospital Swedish Edmonds The Polyclinic Providence Centralia Hospital Swedish Issaquah Overlake Medical Center Swedish First Hill Skagit Regional Health Multi. Care Health System Swedish Cherry Hill Minor & James Medical Multiple physician practices Pacific Medical Centers (Pac. Med) Puget Sound High Value Network: Edmonds Family Medicine Evergreen Health Partners Multicare Connected Care Overlake Medical Center Seattle Children’s Virginia Mason

Does Consolidation Impact the Triple Aim? UW Medicine and VMC: • Access to commercial ACO contracts • Access to clinical expertise • Access to research opportunities • Sharing of best practices within the system • Sharing of best practices with community providers

Are delivery systems changing? ----The VMC Experience • Changed RN Focus to Care Management (2013) • RN Care Manager Training (AAACN) • Evolved Disease Management to High Risk Holistic Care Management (2014) • Re-Aligned Quality Metrics • Re-Aligned Team Metrics • Focused on Patient Experience (2013) • Created RN Panels (2014) • Medical Home Recognition (2015) • Risk Scoring Imbedded in EMR • Healthy Planet/Registry Development • Shadowing/Teaming with IP Care Mgt

Challenges…. Open Medical Staff (ex. 60 -65% of patients seen in urgent care and specialty care have PCP out of network) Alignment of leadership Changing demographics: South King County increasing obesity, low income, low literacy, more diversity Provider burn out (ex. too many clicks) Complicated and overly prescriptive care management contract specifications Conflicting ACO contract(s) objectives RN Care Manager panel growth and management (65 -200 patients/RN) And more………. .

Challenges…. • Fee For Service/Volume/Visit orientation in Shared Savings arrangements • Reliance on downstream revenue • How to fund population management infrastructure • Pot at the end of the rainbow? • Volume based Chronic Care Management? • Capitation?

Challenges… Is it getting better? You tell me.