Amid the many mergers and acquisitions sweeping through healthcare, some raising the ire of anti-trust regulators, four health systems in greater Philadelphia are taking a different tack.
Abington Health, Aria Health, Crozer-Keystone Health System and Einstein Healthcare Network are trying to improve clinical coordination and test new payment models, but without consolidation. Instead, they have initiated a new organizational collaboration called the Noble Health Alliance.
Abington, Aria and Einstein formed the new nonprofit last July "as a vehicle for developing a clinically integrated network and population health organization," said Noble's president and CEO Lynda Mischel. Crozer-Keystone then joined in November.
"The three original CEOs had been thinking about ways they might work together to develop a population health management program that would not include institutional consolidation," said Mischel, former chief development officer at Aria Health, a three-hospital system based in north Philadelphia.
"Consolidation efforts are very complicated in healthcare and slow to really come together. If institutions really want to make a difference for their populations soon, an alternative to consolidation is required," said Mischel, who also worked as COO of radiation oncology at the University of Pennsylvania Health System.
The health systems, particularly Crozer-Keystone, had already been working on integrated care models, and their geographies seemed "complementary rather than competitive," she said. Abington covers parts northwest of the city, Aria the northern city limits and suburbs, Crozer-Keystone the southern and southwest suburbs, and Einstein both the city, with its 772-bed teaching hospital, and the western suburbs.
There are also major problems waiting to be addressed by providers. In a region with more than 60 hospitals, including several independent medical centers, care coordination and information sharing between unaffiliated institutions are still lagging.
"It's pretty early going in southeastern Pennsylvania for that," Mischel said, referring to the exchange organization HealthShare of Southeastern Pennsylvania, which is piloting cross-institution patient record and image sharing with a few health systems.
Accessing patient information
With 15 hospitals and about 4,600 physicians and clinicians across the four health systems, patient information access is one of the major problems the Noble Health Alliance is trying to solve, Mischel said.
"Our goal is to make sure physicians have at their fingertips systems that allow them to understand where and with whom their patients are having whatever kind of care they're getting across the four institutions, as well as help physicians choose speciality referrals in the network," Mischel said.
"We are anticipating and investigating systems of several types that would connect our physicians so they can have a better experience with patient data, and so patients can have a better experience when they're moving through any health encounter," she added.
Noble's four health systems are going to be testing that approach in caring for their own employees.
All of the employees and their covered family members will offered the Noble Health network as part of their health benefits through the organizations' self-funded health plans. A committee of physicians is currently developing quality metrics that will asses their progress in care coordination, particularly for employees with chronic conditions.
Though not a primary goal, it "might lead to program development across the four institutions" and help inform projects with commercial payers and potential participation in Medicare accountable care organizations, Mischel said.
For commercial payers, "We hope we will come together as partners to develop narrow network products for commercially insured beneficiaries across our region," she said. "We are in active discussions with several payers about those opportunities."
For Medicare, leaders from the four systems are considering joining the shared savings ACO program and still doing "readiness assessments," she said. "It's certainly on our radar but we have not yet made a decision."
While the Noble Health Alliance's projects, such as quality metrics for the employee benefits plan, are still being developed, the long-term the vision is to have the four health systems serving patients as an integrated network and offering "a new way for healthcare providers to work with insurers," Mischel said.