As value-based payment models evolve, providers are challenged to maintain superior clinical outcomes while controlling costs. Aligning health professionals around standard care protocols, payment incentives, technology infrastructure, and performance monitoring is complex, but it is possible with a clinically-integrated network (CIN).
In 2014, St. Mary’s Hospital and Regional Medical Center, a facility that serves Grand Junction, western Colorado and eastern Utah, partnered with Guidehouse to evaluate the viability of a CIN with Primary Care Partners of Mesa County, Colorado. The independent primary care physicians group and other physician affiliates wanted to create a more collaborative, low-cost approach to population health and to adapt to changing market conditions.
During the assessment stage, Rocky Mountain Health Plans, an independent, not-for-profit health insurance carrier headquartered in Grand Junction, joined the cooperative adding payer expertise to the enterprise. The organizations established a set of 10 guiding principles that their partnership must accomplish, including achieving continuous improvement toward the Triple Aim, benefiting all parties and the community, and creating shared governance while maintaining physician autonomy.
St. Mary’s Hospital and Regional Medical Center, Primary Care Partners and Rocky Mountain Health Plans:
Legally formed Monument Health, a CIN, in the state of Colorado
Launched various clinical improvement initiatives using a common infrastructure to include:
Improved care models for various populations that begin with a ‘whole person’ assessment
Improved multi-disciplinary coordination of care that promotes consistency across the continuum through use of a ‘quarterback’ approach
Active patient and family engagement techniques that are shared across the network
Filed an application for a qualified health plan to be offered on the Colorado healthcare exchange, Connect for Colorado, for the 2016 open enrollment season
Responded to a RFP from the Mesa County Health Plan for network and administrative services
Positioned for additional value-based contracts for the network’s attributed lives