IMPROVING HEALTH OUTCOMES OF PATIENTS WE SERVE

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1 IMPROVING HEALTH OUTCOMES OF PATIENTS WE SERVE F E B RUARY

2 UPDATE Director s Update: Collaborative Continues to Add Value Network Improves Health Care Access and Coordinated Care for Patients In 2014, the vision of six health systems was realized with the formation of the Health Network of Missouri. The network allowed the systems Bothwell Regional Health Center, Capital Region Medical Center, Hannibal Regional Healthcare System, Lake Regional Health System, Saint Francis Healthcare System and University of Missouri Health Care to collaboratively work together while maintaining their own independence. The network recognized then and recognizes even more so now the need to collectively work together on increasing access to care in each of our communities and improving clinical outcomes while containing costs. The network continues to provide the value proposition to the stakeholders we serve of moving toward value-based reimbursement and true population health management. While you read this update, you will recognize that we have accomplished much this past year. However, the challenge remains, and we have a lot of opportunity ahead of us in It will be a pivotal year as we look to implement many of our initiatives and to grow the network. I want to thank the leadership of our each our member organizations as well as the task force leaders and members for all the hard work displayed. Without our collective effort and leadership, we would not be able to achieve our goals. Thank you, TOM TISONE EXECUTIVE DIRECTOR HEALTH NETWORK OF MISSOURI Health care across the nation is changing rapidly. To address these changes, hospitals and health systems are innovating new ways to improve the health of populations, enhance the experience and outcomes of the patients, and reduce per capita cost of care for the benefit of communities. The Health Network of Missouri (HNM) has six member organizations: Bothwell Regional Health Center in Sedalia, Capital Region Medical Center in Jefferson City, Hannibal Regional Healthcare System in Hannibal, Lake Regional Health System in Osage Beach, Saint Francis Healthcare System in Cape Girardeau, and University of Missouri (MU) Health Care in Columbia. The network s structure allows members to work together as partners on common goals while enabling each hospital or health system to serve the health care needs of its own community and preserve its independence and unique identity. The six members serve patients in counties throughout central, northeast and southeast Missouri and have more than 1,000 hospital beds, nearly 11,000 employees and approximately 1,200 employed and affiliated physicians. The three task forces actively seek opportunities to be more efficient, increase impact, and improve the lives of people across Missouri. These health systems work together to share best practices in business, clinical and operational practices. Major initiatives of the HNM task forces include: Continuing to improve the health outcomes of patients Sharing data and best practices Improving access to care Ensuring patient care among various providers is coordinated seamlessly through a clinically integrated network Lowering health care costs and creating efficiencies that will benefit the patients and communities HNM systems serve 2 \ Health Network of Missouri \ February 2018

3 CARE COORDINATION TASK FORCE Read about the Health Network of Missouri at CO-CHAIRS, Care Coordination: CO-CHAIRS, Post-Acute Care Team: RANDALL HAIGHT, MD SENIOR VICE PRESIDENT OF MEDICAL AFFAIRS, CAPITAL REGION MEDICAL CENTER MIKE SEDA DIRECTOR OF REGIONAL OPERATIONS, TIGER INSTITUTE FOR HEALTH INNOVATION, GREG WORSOWICZ, MD, MBA CHAIR, MU DEPARTMENT OF PHYSICAL MEDICINE AND REHABILITATION MEDICAL DIRECTOR, RUSK REHABILITATION CENTER EMILY ROYAL, MHA BUSINESS DEVELOPMENT AND PROGRAM MANAGER, HANNIBAL REGIONAL HEALTHCARE SYSTEM Tech for transitions The care coordination task force continues working toward its objective to achieve demonstrable improvement in care coordination between network organizations and to reinforce seamless care transitions between home, community and quaternary care. The task force is co-led by Randall Haight, MD, vice president of medical affairs at Capital Region Medical Center; and Mike Seda, director of regional operations, Tiger Institute for Health Innovation, MU Health Care. Achieving the established initiatives will rely on the latest technology and the ability to share data quickly and securely. The task force is currently working on two initiatives aimed at improving care coordination: population health platform governance and post-acutecare transitions. The Health Network of Missouri chose Cerner s HealtheIntent as its shared population health management platform. HealtheIntent is a cloudbased, programmable, population health management platform that is vendor-agnostic, which means it can receive data from any electronic medical record, information system or other data source, such as pharmacy benefits manager or insurance claims. This establishes a longitudinal record for individual members of the population for which an organization is held accountable for health outcomes and costs. Solutions built on the platform can be securely accessed anywhere, anytime. The platform identifies and stratifies populations to pinpoint gaps in care, enabling organizations to act on information and match the right care programs to the right people. Prior to sharing data, a comprehensive readiness assessment was completed at each member health system to better understand the current IT infrastructure and capabilities for managing patients receiving care at HNM facilities. Capital Region Medical Center is finalizing its data onboarding and will be live on the platform in early Hannibal Regional Health System is in the process of onboarding its information into HealtheIntent and is targeted to be live in mid The post-acute care team is led by Greg Worsowicz, MD, MBA, chair of the MU Department of Physical Medicine and Rehabilitation and medical director of the Rusk Rehabilitation Center, and Emily Royal, MHA, business development and program manager at Hannibal Regional Healthcare System. The team is currently working to create patient education that details the various types of post-acute care available and what patients can expect in each setting. Additionally, the team is tasked with standardizing the information given to patients regarding postacute-care institutions using publicly reported data. Future initiatives include improving management of transitions between member health systems and their respective postacute-care provider partners. Health Network of Missouri \ February 2018 \ 3

4 Population Health and Quality Improvement Task Force CO-CHAIRS, POPULATION HEALTH: CO-CHAIRS, QUALITY IMPROVEMENT: VINCE COOPER DIRECTOR, MANAGED CARE & SYSTEM CONTRACTING, KEVIN MCROBERTS SENIOR VICE PRESIDENT OF OPERATIONS, LAKE REGIONAL HEALTH SYSTEM TOM DIEMER, MD VICE PRESIDENT OF QUALITY AND SAFETY, SAINT FRANCIS HEALTHCARE SYSTEM KRISTIN HAHN-COVER, MD CHIEF QUALITY OFFICER, Aligning quality and use measures for patient populations The population health and quality improvement committees are combining efforts to ensure alignment and progress toward their next area of focus: quality and utilization measures for HNM health system employee health plan populations. INITIAL REVIEW WILL INCLUDE: Hospital data (2015) for Cardiac Episode Payment Models Clinically integrated network measures MACRA program and measures LONG-TERM GOALS INCLUDE: Leveraging analytics tools to identify improvement opportunities and strategic projects across the network. Equipping each of the sites to provide point-of-care tools for better management of patient populations. Exploring opportunities to market these initiatives to other employers. Currently, member facilities are completing readiness assessments and developing timeframes for individual sites to bring the technology online. 4 \ Health Network of Missouri \ February 2018

5 ALLIANCE TASK FORCE Read about the Health Network of Missouri at CO-CHAIRS: TOM TISONE EXECUTIVE DIRECTOR, HEALTH NETWORK OF MISSOURI KRISTEN MEADE DIRECTOR OF SUPPLY CHAIN, UNIVERSITY OF MISSOURI SYSTEM, BRAD MYERS DIRECTOR OF PHARMACY SERVICES, TJ SWEET PRACTICE MANAGER, ELLIS FISCHEL CANCER CENTER, Collaboration brings stronger outcomes and shared savings for members The alliance task force is focused on identifying, evaluating and implementing initiatives to support members in serving their communities health needs. The task force is active in creating solutions in several sub areas, including supply chain management, as well as physician recruitment and retention. COST SAVINGS FOR MEMBERS In 2017, the Health Network of Missouri achieved more than $2.9 million in cost savings across the network, most of which came from technology savings. This is about $550,000 in savings a year for each member organization. Part of this cost savings can be attributed to group purchasing options now available to HNM members as secondary affiliates of MU, which allows the organizations to access the university s academic tier pricing. $514, $2,909, Additionally, the supply chain subgroup continues to review capital alignment of member organizations to determine whether there are large group buys member organizations can make together for shared cost savings. The committee is considering a few options to minimize prescription costs and improve patient care. One option the committee is evaluating is managing pharmacy costs for members through a common drug distributor. The committee also is exploring the possibility of a specialized pharmacy for all HNM members to help manage patients with chronic conditions such as COPD or diabetes. Additionally, the committee is considering a virtual medication management initiative to improve cost of care to patients and to improve quality of care as well as patient outcomes. ALLIANCE HELPS SERVICE LINES SHARE STRENGTH When Capital Region Medical Center s Goldschmidt Cancer Center replaces its linear accelerator in May 2018, their patients undergoing treatment will need to receive care elsewhere. These patients will be able to continue to receive their treatment, without interruption, at MU Health Care s Ellis Fischel Cancer Center, a short drive away, thanks to an agreement between Capital Region and MU Health Care. MU Health Care s mobile mammography van, Mamm Van, continues to travel throughout the state to bring services to those in remote areas. Read more about the collaboration between MU Health Care and Saint Francis to bring mammogram services to Southeast Missouri on page 10. Health Network of Missouri \ February 2018 \ 5

6 ALLIANCE TASK FORCE Recruiting and retaining physicians in high-need areas MICHELLE KENNEY, MD Michelle Kenney has many different skills. As a native Missourian raised on a farm north of Kirksville, Missouri, she can round up a herd of cattle and load hay to feed them. As a resident physician trained in pediatric medicine at the University of Missouri, she can check the heartbeat of children and provide care for them. Kenney s unique set of skills represent the accumulated experience of life on a farm, four years at the MU School of Medicine, three years of physician residency, a passion for keeping children healthy and an awareness of the rural physician shortage in Missouri and throughout the country. This has been an ongoing problem for years and it s likely to get worse, Kenney said. I feel like everyone should have good care, and it should be available and not something that is granted only to people in urban areas. If we re ever going to target the overall health of the country, access is huge. According to a 2017 report by the Missouri Department of Health and Senior Services, 99 of 114 Missouri counties don t have enough physicians, with 86 percent of the state classified as health profession shortage areas. Kathleen Quinn, PhD, associate dean for rural health at the MU School of Medicine, said it has long been hard to recruit new doctors to rural America and, specifically, to rural Missouri. In Missouri, about 18 percent of physicians practice in rural communities but 37 percent of our population lives there, Quinn said. We really need more physicians in rural communities to meet the health care needs of rural Missouri. To address this problem, the MU School of Medicine has added a program to train doctors to provide health care in rural communities. The program gives resident physicians the option to do a one-month rotation in a rural clinic, including Health Network of Missouri member health systems. Medical students interested in rural health also may complete clinical training at Health Network of Missouri member facilities through a similar program. The rural residency program is funded by an annual $200,000 Rural Medical Services grant from the Missouri Department of Health and Senior Services. The program plays an important role for resident physicians considering rural medicine. Kenney s family still resides on the cattle farm a few miles north of Kirksville where she grew up. She had always dreamed of moving back to her hometown, helping her dad with the farm and practicing medicine, but she wasn t completely sure how she was going to do that. Her experiences during the rotation in March 2017 prepared her for many of the unique challenges that come with rural medicine. That hands-on experience is what ultimately led Kenney to commit to practicing medicine near her hometown. One of the biggest concerns is the perception that you re a little bit more isolated in a rural area, Kenney said. I discovered there are more resources for rural physicians than I thought. Also, I did enjoy the challenges of stretching my skills into other specialty areas. Since the MU program began in 2016, four resident physicians have completed it, and all plan to work in rural areas when they graduate in May Of our medical students who have participated in one of the rural medical programs offered at MU since 1995, 45 percent ended up practicing in rural Missouri, Quinn said. We want to add even more physicians to rural Missouri with this program. It gives resident physicians valuable experience and confirmation that rural medicine is what they want to do. If they train in a specific rural community, they re more likely to go back and work there. After Kenney completes her residency in May 2018, she plans to return to her roots and put her medical expertise into practice at Northeast Missouri Health Council Pediatrics, a children s health clinic in Kirksville, Missouri. Meanwhile, her husband, Martin, will be the one rounding up cattle on the family farm. KATHLEEN QUINN, PHD Associate Dean for Rural Health, MU School of Medicine ANN WADE Program Coordinator, Rural Track Pipeline Program, MU School of Medicine 6 \ Health Network of Missouri \ February 2018

7 value partnership committee HNM and Cerner develop strategic relationship to scale population health capabilities CERNER BOTHWELL REGIONAL HEALTH CENTER Phil Fracica, MD Chief Medical Officer CAPITAL REGION MEDICAL CENTER Tom Luebbering Vice President Finance LAKE REGIONAL HEALTH SYSTEM Kevin McRoberts Senior Vice President Operations HANNIBAL REGIONAL HEALTHCARE SYSTEM Tim Polley Vice President Business Development SAINT FRANCIS HEALTHCARE SYSTEM Maryann Reece Executive Vice President and Chief Operating Officer MU HEALTH CARE Kristen Han-Cover, MD Chief Quality Officer Cole Erdman Director Clinical Intelligence Steve Kirsch Vice President & Performance Improvement Executive David Roberts Senior Population Health Solution Strategist Since its inception, the Health Network of Missouri has focused on a few key objectives: sharing data and best practices, improving health outcomes, and lowering costs for patients in member organizations communities throughout the state. These objectives support population health management. However, obtaining data to achieve these objectives was difficult, if not nearly impossible. Information from the six health systems included inconsistent definitions, different timeframes and was not always actionable. In order to achieve shared goals, the network needed a common technology platform to succeed. In January 2017, HNM and Cerner entered into a strategic relationship that would allow HNM members a low cost of entry into the population health management space. A fundamental requirement of the platform was that it be EMR agnostic, as all six HNM health systems have different EMRs. The platform will allow each health system to load EMR and claims data into one system so HNM can effectively and efficiently manage specific patient populations as well as identify and work on quality initiatives together as a collaborative. The long-term goal is to create a longitudinal medical record that will allow for seamless transitions in care between member health systems and their physicians. The relationship also calls for the creation of a new committee that includes leaders from each health system and Cerner. This group is called the Value Partnership Committee and has a charge to evaluate value opportunities, to identify strategies and resources needed from Cerner and HNM to improve performance and measure outcomes. The group meets monthly and is in the process of developing a project charter to enhance medication management across the network. Health Network of Missouri \ February 2018 \ 7

8 Health Network of Missouri Members BOTHWELL REGIONAL HEALTH CENTER Bothwell Regional Health Center includes a 145-bed hospital in Sedalia, Missouri, and 13 clinics located throughout Sedalia, Cole Camp and Warsaw, Missouri. In addition to offering primary care and more than 30 specialties, Bothwell has the only cath lab for heart care in west-central Missouri. It also offers full-time cardiologists, cancer specialists and orthopedic surgeons, plus an accredited sleep center, accredited wound healing center and dedicated cancer center. To learn more about how you can get well and stay well at Bothwell, visit HANNIBAL REGIONAL HEALTHCARE SYSTEM Hannibal Regional Healthcare System is the parent organization of Hannibal Regional Hospital, Hannibal Regional Medical Group and Hannibal Regional Hospital Foundation. Hannibal Regional Hospital is a 91-bed acute care hospital providing comprehensive health and wellness services to more than 125,000 residents in the tri-state area. Hannibal Regional has been ranked as No. 74 among healthcare providers and insurers by Modern Healthcare s 2017 Best Places to Work in Healthcare. Hannibal Regional Medical Group is a growing multispecialty physician group delivering primary, specialty and express care services at nine locations in Missouri and Illinois. For more information on Hannibal Regional Healthcare System, visit CAPITAL REGION MEDICAL CENTER Capital Region Medical Center, an affiliate of MU Health Care, encompasses a full-service hospital, a comprehensive cancer program at Goldschmidt Cancer Center, a home health agency and an expansive clinic system covering eight counties. CRMC is Jefferson City s only designated stroke center and provides access to robotic surgical services. Within the hospital, the Inpatient Rehabilitation Center is one of the few accredited hospital-based rehabilitation centers in the state. Capital Region s fitness facility, the Sam B. Cook Healthplex, is the community s only hospital-based, medically directed fitness facility and is home to adult and pediatric outpatient therapy services. From prenatal and obstetric care to orthopaedic and cardiovascular services, Capital Region provides innovative health care, advancing its mission to improve the health and wellness of the communities it serves. For more information, visit 8 \ Health Network of Missouri \ February 2018

9 Read about the Health Network of Missouri at LAKE REGIONAL HEALTH SYSTEM Lake Regional Health System provides comprehensive health care services for residents and visitors in a fivecounty region surrounding the Lake of the Ozarks. The hospital, located in Osage Beach, is a three-time recipient of the Missouri Quality Award and is a state-designated Level II Stroke Center and Level III Trauma Center. Lake Regional offers complete cardiac and orthopedic care, women s health services, an accredited Cancer Center and an accredited Sleep Center. In addition, the health system operates 31 clinics, including primary, specialty and walk-in care, as well as rehab therapy clinics, retail pharmacies, and home health and hospice services throughout the lake area. To learn more, visit SAINT FRANCIS HEALTHCARE SYSTEM Saint Francis Healthcare System is anchored by Saint Francis Medical Center, which is a 308-bed facility serving more than 713,000 people throughout Missouri, Illinois, Kentucky, Tennessee and Arkansas. Guided by its mission to provide a ministry of healing, wellness, quality and love inspired by its faith in Jesus Christ, the Medical Center has become a progressive, innovative regional tertiary care referral center. Saint Francis major service lines, which have received national recognition, include the Neurosciences Institute, Orthopedic Institute, Family BirthPlace (featuring the region s first Level III Neonatal Intensive Care Unit), Heart Hospital, Emergency and Trauma Center, Cancer Institute and Fitness Plus. For more information, visit As part of the state s premier academic medical center, University of Missouri Health Care offers a full spectrum of care, ranging from primary care to highly specialized, multidisciplinary treatment for patients with the most severe illnesses and injuries. Patients from each of Missouri s 114 counties are served by approximately 6,000 physicians, nurses and health care professionals at MU Health Care. MU Health Care facilities include Ellis Fischel Cancer Center, the Missouri Orthopaedic Institute, the Missouri Psychiatric Center, University Hospital, and Women s and Children s Hospital in Columbia. Affiliates include Capital Region Medical Center in Jefferson City, Columbia Family Medical Group, Columbia Surgical Associates and Rusk Rehabilitation Center. New clinic locations in 2017 include Family Medicine - Fulton Family Health and the Family Medicine clinic in Ashland. MU Health Care is a founding member of the Health Network of Missouri and MPact Health. More than 50 MU Health Care outpatient clinics in central Missouri receive outpatient visits exceeding 550,000 annually. For more information, visit Health Network of Missouri \ February 2018 \ 9

10 Collaboration Across Member Organizations Taking patient care on the road Saint Francis is thrilled to have partnered with the University of Missouri to bring the mobile mammography van or Mamm Van to Southeast Missouri July 5-7, The Saint Francis Foundation funded this initiative through the Pink Up campaign. We know there are patients in our area that can t get to us to have their annual screening, said Jimmy Wilferth, Saint Francis Foundation executive director. The Mamm Van is helping us meet the needs of those who don t have the means to come to us. Along with staff from the University of Missouri, Saint Francis family members Sabrina McAllister and Robyn Hindman from Womancare assisted with registering patients and making the process go as smoothly as possible. It was a very humbling experience, Hindman said. The services we provided were much needed, and they were all appreciative. Over the course of three days, the Mamm Van visited the Stoddard County, the New Madrid County and the Mississippi County Health Departments. They saw a total of 61 patients in three days and were able to give them not only medical care, but also someone to talk to. Some of these women were able to share their stories with us, McAllister said. They have had so many hardships, and this service was a godsend to them. As both McAllister and Hindman recalled the days on the van, they were emotional when they thought of the needs they saw and how these patients couldn t even get to a medical facility for their care. We have absolutely nothing to complain about, McAllister said. The things that these women are dealing with we are blessed. The ability to give a mammogram was more than just for health. It was also for peace of mind. Some of these women were able to share their stories with us. They have had so many hardships and this service was a godsend to them. Sabrina McAllister This process gave some peace of mind, Hindman said. It was one less thing for them to worry about. Both Hindman and McAllister were thankful for the University of Missouri staff members and said they quickly became family. When you meet people who share your desire to help women, it motivates you to keep helping, McAllister said. We didn t want to turn anyone away, so we just kept working. The Mamm Van will make its second Saint Francis sponsored tour in March *Originally published in Saint Francis Healthcare System s Powerline family newsletter 10 \ Health Network of Missouri \ February 2018

11 Health Network of Missouri STRUCTURE CAPITAL REGION MEDICAL CENTER LAKE REGIONAL HEALTH SYSTEM UNIVERSITY OF MISSOURI HEALTH CARE BOTHWELL REGIONAL HEALTH CENTER HANNIBAL REGIONAL HEALTHCARE SYSTEM SAINT FRANCIS HEALTHCARE SYSTEM CERNER Board of Managers Finance and Accounting Communications Executive Director Tom Tisone Legal Counsel Mark Thompson Administrative Assistant Karla Church Project Management HNM Value Partnership Committee Care Coordination Task Force Population Health/ Quality Improvement Task Force Alliance Initiatives Task Force Health Network of Missouri \ February 2018 \ 11

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