Health System Collaboratives

Contributor: Paul Tirjan, BA’89, WG’01
To learn more about Paul, click here.

image001.jpgJust over a year ago, I embarked on a new journey into the realm of collaborative alliances among not-for-profit integrated healthcare systems.  The proliferation and maturation of this type of non-merger partnering organizational framework has led to the formation of SRHO (Strategic Regional Healthcare Organizations), the national association, earlier this year.  My organization, AllSpire Health Partners (AHP), a founding member of SRHO, has five health systems, thirty-six hospitals, ten thousand physicians, seventy-five thousand employees, and serves a community of greater than ten million residents.

Like others that sprouted up from 2011 to 2015, AllSpire began as an exploration of how best to adapt and respond to the Affordable Care Act, but quickly expanded in scope to include many traditional aspects of value creation in healthcare.  Initial efforts were strictly clinical quality process improvement efforts.  With each new successful initiative, confidence in the power of the collaborative and trust in peer members built up to support bigger and bolder endeavors.

As an SRHO, AllSpire is an organization of independent health systems bound together largely by trust, with rules codified in written agreements.  The rules are important guidance and are necessary, though not sufficient, to establish trust.

Certain fundamental principles must be observed in the behavior of alliance members to build the kind of trust that enables them to endure.  The extent to which these principles are evident in all aspects of these collaborative relationships determines the corporate culture of the enterprise and impacts prospective members, employees, patients, business partners, vendors, regulators, and the general public in our communities.

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The Mission

“The Mission of AllSpire is to harness and share the accumulated wisdom, talent and resources of our integrated health system members, via knowledge transfer and collaboration, to achieve the highest levels of Clinical Excellence, Patient Affordability, Access and Experience and Economic Sustainability, all for the benefit of the communities we serve.”

These Core Aspects equate to our version of a Triple Aim:

 

  • Clinical Excellence

–      Knowledge Transfer

–      Collaboration

–      Innovation

–      Research

 

  • Patient Affordability, Access and Experience

–      Price Transparency

–      Encouragement of Lower Cost Services and Sites of Care

–      Informed Patient Decisions on Utilization

–      Connected Health and Virtual Care

 

  • Economic Sustainability

–      Purchasing

–      Efficiency

–      Investment

 

Clinical Excellence

Knowledge Transfer at AllSpire is a formal program to share data, information, knowledge, methods, and lessons learned among collaborative peers. These programs and initiatives have both inherent value and enabling value. In its purest form, Knowledge Transfer focuses attention on the most critical decisions, which is inherently valuable in process improvement, education, and standardization. Beyond benchmarking and improved independent decision-making, secure and efficient Knowledge Transfer is the most critically necessary foundational element enabling Collaborative Ventures, Research, and Innovation.

Collaborative Ventures at AllSpire refers to initiatives that are undertaken together by two or more independent health systems and result in the creation of an ongoing entity or contractual arrangement.

Innovation at AllSpire refers to coordinated activities of the innovation resources at each member health system, as well as strategic partners from industry, that advance the Mission, Vision, and Values of AllSpire above the level that any one member could attain on their own.

Research at AllSpire means formal investigative study of conditions, treatments, and operational processes that might offer an opportunity to raise the bar of clinical quality in efficacy and safety and/or lowering cost and raising efficiency.

Patient Affordability, Access and Experience

Healthcare is too expensive to be sustainable in its current form.  Too many people simply cannot access the system.  Nearly always, that lack of access is the result of financial inadequacy.  Those who can access healthcare do not enjoy a uniform customer service experience, much less a uniformly high level of customer service.  Again, this variation in experience of care is heavily impacted by cost in many cases.  The cost-to-the-patient challenge begins with coverage and premiums, but also includes co-payments, co-insurance, deductibles, indirect costs, and other out-of-pocket expense.

The senior leaders of AllSpire have resolved to take on the root cause of what ails the American health system by explicitly making total-cost Patient Affordability, Access and Experience, for all patient populations, a core aspect of AllSpire.  Initiatives enhance transparency in cost, quality, and value.  Priority is given to projects that encourage use of lower cost sites of care options, and especially that support better self-care of chronic conditions.

Programs will be expanded, and made simpler, to access primary care.  Virtual Care will be implemented whenever clinically appropriate to minimize patient out-of-pocket expense in travel and time off from work for routine care.  The progression from EMR to EHR will further expand beyond the formal health system to first track, and later help to organize family and neighborhood caregivers with the goal of improving the social determinants of health.  In the longer term, this connected health system will operate as a single coherent whole producing better clinical outcomes and better quality of life for patients.  In the near term, greater communication among disparate providers will help reduce waste in the system from duplicate or unnecessary procedures.

Aspirationally, these initiatives will stand as an example to the nation and establish new standards that may move American healthcare in a more sustainable direction.

Economic Sustainability

AllSpire Health GPO is a major collaborative venture that launched on October 1, 2016 after three years of intensive planning and negotiation.  The result is a new company owned by the AllSpire Health Partners member health systems, which is dedicated to improving quality and reducing cost across the full spectrum of supply chain purchasing contracts.  This signature collaborative venture has generated more than $30 million in direct cost savings in its very first year of operation, representing a > 5x ROI multiple of aggregate investment since inception in 2013.  These results will at least replicate annually, and likely improve.  

Our GPO staff are integrated into the independent Value Analysis Teams (VATs) within each AllSpire member health system, as well as into national clinical advisory boards (via HealthTrust).  Many activities in Clinical Excellence and Patient Affordability, Access and Experience leverage the Value Analysis Teams who are tied together by Collaborative Coordinators at our AllSpire Health GPO.   In turn, the GPO/VAT team leverages the AllSpire Health Partners team in clinical and administrative affairs.   Two senior executives, one VP from the AH GPO and one VP from AHP, form a dyad in co-leading the creation of additional Collaborative Ventures that have both a clinical and economic component.  

Future efforts will include procurement, development, and investment in disruptive technologies being applied to healthcare, as well as new business models of care delivery.

 

Contact Paul at: Paul.Tirjan@allspire.org