Strategic Planning for a Regional Health Consortium
Client/Profile
The Adirondack Health Institute, in Queensbury, NY is a joint venture of two health systems and a physician group, with a combined service area spanning eight counties in the rural Adirondacks region
Challenge/Situation
To create a new organization to manage and integrate the oversight of a multi-payer and multi-county patient-centered primary care medical home pilot program. Three existing clients were jointly granted state and federal funding to establish this demonstration project. The medical home pilot encompasses 35 primary care practices with over 200 providers, five hospitals, seven commercial health plans, and Medicare and Medicaid, among other constituents.
Since completion of our work, the participating members have experienced reduced ED admission rates, improved quality indicator performance metrics, reduced admissions for chronic conditions, and have successfully recruited additional primary care physicians to the region.
Process
Veralon worked collaboratively with all three entities and a number of external stakeholders at the state, regional and local levels to build a centralized organizational framework and establish the strategic plan for what is now Adirondack Health Institute (AHI). As a regional health consortium, AHI has been effective at working with local health care and social services providers through the coordination of planning, recruiting, clinical activities, outreach and oversight of multiple grant-supported programs, including the medical home pilot.
AHI has demonstrated efficacy in uniting and coordinating local health care and social services providers across a broad a rural geography for planning, recruiting, care management, facilitated enrollment and other education, engagement and outreach of the regional population.
We later re-engaged with AHI to support the transition of pilot activities to a clinically integrated network/ACO model to expand regional collaboration with payors and providers, sustain and enhance the positive impact of the pilot and re-evaluate the strategy of AHI given its evolving role.
Results
Results of the pilot to date indicate improved access to high-quality, cost-effective primary care as evidenced by attainment of NCQA medical home accreditation for all participants, reductions in unnecessary utilization at regional hospitals and increased recruitment and retention of primary care providers. Detailed results included:
- Significantly lowered avoidable admissions, ED visits and readmission rates per 1,000 population for COPD, pneumonia and CHF for enrolled patients
- Risk-adjusted pm/pm utilization rates and total expenditures for commercial and Medicaid lives steadily trending downward
- Substantial improvement in wellness metrics for the chronically ill with diabetes and COPD post-enrollment in care management and transitions program
- Enrollee survey satisfaction metrics for access, timeliness and communication with providers now exceed the national 75th percentile (CAHPS).