Rival Systems Realize They Gain From Collaboration

Lately, healthcare leaders at rival organizations seem increasingly likely to pick up the phone, call each other, and ask if they'd like to meet for a drink.

But these aren't social calls. These folks are trying to find opportunities to improve care.

Last week, for example, I wrote about CEOs from four small rural hospitals in Central West Texas that dropped their town rivalries to collaborate on the purchase of a single electronic medical record system that would bridge their hospitals, and eventually their clinics and physicians, with their patients' health histories.

This week, members of two California health information technology groups, which used to fiercely wrangle, will join hands to form Cal eConnect; as one entity they will provide leadership and oversight so that California health providers get every penny of the $3 billion in stimulus funds available for meaningful use. That's the biggest pot of HIT change of any state in the country. Cal eConnect will get $38.8 million in federal funds routed through the state to make it all happen.

There's more. I recently heard that two major hospitals in Nebraska, which normally vie for patients—the Methodist Health System and the Nebraska Medical Center—agreed to a special project that would improve patient care through the creation of a unified accountable care organization (ACO).

The idea is that by having their physicians and surgeons, nurses and other providers track patients from the hospital to the physician's office to the home, each system will drastically reduce avoidable hospital readmissions and improve patient compliance.

I spoke last week with Ken Klaasmeyer, vice president for MHS' Methodist Health Partners, and Rita Potter, director of managed care for the Nebraska Medical Center, who told me their hospitals are the only competing systems in the U.S. attempting to share information for an ACO model.

Combined, the two organizations have 50% of the healthcare market of the greater Omaha region, so it stands to reason that they would share patients and that both would stand to gain by tracking care better.

Klaasmeyer and Potter explained that their joint effort would encourage a variety of providers at both facilities to better manage their patients' care through educational classes, appointment reminders, follow-up visits, well-being phone checks and many other strategies.

Health system personnel can make sure patients fill their prescriptions, schedule and keep their appointments, and anticipate any adverse reactions they may have to their regimens.

"Patients who come to the hospital with certain chronic diseases—for starters diabetes, hypertension or congestive heart failure—will be tracked," Klaasmeyer says.

"We want to know, 'how do we encourage the patient to become complaint?' That's the $64,000 question. Maybe it's a phone call, or having the doctor make a house call; nothing is off the table," he says.

Potter and Klaasmeyer note that the process and reimbursement of these services is all new for both facilities. Nevertheless, the facilities expect that the amount of money spent establishing this program will be recaptured when chronic care patients aren't readmitted—care which the federal government is increasingly reluctant to reimburse.

Interestingly, chronic care has become such an issue that the leaders of the ACO are looking into an effort to have hospital officials meet with employers in the greater Omaha area to encourage them, possibly even with financial incentives, to promote healthy living among their workforces.

Diabetes is an especially important area for new ideas, Potter notes, because 30-40% of the patients admitted to the health systems' hospitals present with diabetes, or diabetes is a complication of their admitting illness. "We're looking at attacking the places where we have the greatest chance of improving the outcome of the patient," she notes.

Another area that begs for improvement is the problem of diabetic patients who are non-compliant with their medications or other aspects of recommended care. An estimated 50% of patients with diabetes fall into this category, she says.

The ACO may decide to contact employers with suggestions that they work with their health insurers to restructure their benefit plans in such a way that those employees with diabetes who can show routine compliance with medication management may be allowed to forego paying a co-pay when visiting the doctor.

"We have to remember that we don't have enough money in our healthcare system to continue practicing the way we have been," Potter says.

Adds Klaasmeyer: "If we don't have some impact on reducing readmission rates, then the government and payers are going to do it for us."

Will all the friendly rivalry be put away? Probably not, but Potter and Klaasmeyer hope to make it work to their advantage. The new accountable care organizations culled by Methodist Health Partners and Nebraska Medical Center intends to use friendly competition to see which system's readmission prevention strategies work best.

"At some point, we'll sit back and look at our (readmission) rates and theirs and see who's the best. And then one or the other will ask, 'What are you guys doing to get those kind of numbers?'" Klaasmeyer says.