Legacy Health has launched its own clinically integrated network designed to improve patient care and cut costs, but it's not expected to start operating for more than a year.
Legacy Health Partners, as the network will be known, will be the first of its kind in Oregon: more than 1,000 independent private practice providers from across the Portland metro area collaborating with Legacy Health and Legacy Medical Group, with 1,400 total members. There are no plans to expand beyond Portland for the time being.
Legacy hopes the new network will begin treating patients by January 2016. The 16-member Legacy Health Partners Board, which convened its first meeting earlier this month, will decide whether to contract with payers or directly with employers. Payers are aware of the new network, but no contract discussions have begun.
Legacy Health Partners is designed to deliver the “Triple Aim” of health care reform: better health and better care at lower cost. Many details still need to be ironed out, but hopes are high.
“Our end goal is to improve the patient experience, reduce unnecessary or duplicative services, thereby decreasing costs, and most importantly improve quality and outcomes in a demonstrable fashion,” said Dr. Lewis Low, senior vice president and chief medical officer for Legacy Health, who has led the development of Legacy Health Partners since its inception last year.
“The people who are buying health care–employers, individuals and governments–many of them are looking to deliver care through a clinically integrated network because of the belief that it's a better system to deliver on the Triple Aim,” said Dr. David Shute, medical director and practicing internal medicine physician at Greenfield Health, who served as the chair of the Legacy Health Partners Board Selection Committee.
When done correctly, there are considerable advantages to a clinically integrated network, according to Dr. Bob Dannenhoffer, a private practice pediatrician in Roseburg and former president of the Oregon Medical Association. “I applaud them for giving it a try.”
For example, doctors in a network could share quality metrics or decide as a group to measure screening rates for breast cancer. Electronic medical records make it easier to coordinate care as patients move from one level of care to another or from one doctor to another.
“If a patient comes in and says, 'I'm taking that little white pill,' you can find out what that pill was,” said Dannenhoffer, who is also the CEO of Architrave Health, which was formed by Mercy Medical Center and Douglas County Individual Practice Association to manage the healthcare of county residents enrolled in the Oregon Health Plan.
One of the keys to building an integrated network are electronic medical records. Low said that the company is focusing on clinical and data integration to manage populations of patients. “Legacy Health Partners will provide a new way for physicians to partner not only with Legacy, but with each other.”
But exactly how that will happen remains unclear, according to one doctor participating in the network.
Dr. Warren Roberts, an independent physician specializing in neurological surgery at Aspen Spine & Neurosurgery Center in Tualatin, was excited about the promise of Legacy Health Partners when he first heard about it, and has been involved in preliminary discussions since the very beginning.
He is concerned, however, that there are about 50 different electronic medical records systems currently in use by physicians affiliated with Legacy, and the company has not communicated any plans for how it will reconcile them into a centralized network.
“You can't have 50 different electronic medical records systems,” Roberts said. “Everybody has to be able to talk to each other, particularly primary care physicians and specialists. That's a major obstacle. If those 1,400 doctors aren't talking to each other, then they're not really integrated. It's just a roll call list.”
None of this is lost on Legacy, which requires that every member provider use an electronic medical record before they can join the network. But they don't have it figured out yet. “Creating our data integration strategy and identifying tools and systems to implement to support that work is a top priority for Legacy Health Partners,” Low said.
At its hospitals, Legacy uses software from Epic Systems, Roberts said. It costs about $35,000 to install the software and get it up and running. He chose Athena Health instead for his practice, partly because it's less expensive.
Besides startup costs, another important consideration is control of patient data, particularly for physicians who decide to opt out of the network at some point.
And on top of all that, the toughest obstacle facing Legacy Health Partners may be a philosophical one.
“The biggest challenge new partnerships like this have is that they do not yet fully align the interests of the health insurance function and the health delivery function,” said Michael Leahy, a health sciences professor at Linfield College and founding executive director of OCHIN, the largest health information network in the country. (Full disclosure: Linfield has a long-term lease with Legacy.)
“Only when financial incentives and professional culture is effectively changed will there be a more appropriate balance of prevention versus over-reliance on procedures and treatment that continues to fund a practice,” he said. “Change is hard in any profession.”
Undoubtedly, Legacy Health Partners has a lot of work to do in the coming months. “I think the concept of a clinically integrated network is laudable but very tricky,” said Roberts. “This is a tremendous undertaking.”
Legacy Health Partners named 16 members to its board of directors in September. Overall, 45 providers applied to represent independent primary care, specialty and pediatric providers on the board. Board members include: Dr. Bruce Andison of The Women’s Clinic of Vancouver; Dr. Peter Beatty of Tualatin Imaging; Dr. Robert Bentley of Eye Health Northwest; Dr. DeOna Bridgeman of Davies Clinic; Dr. Mark Buchholz of Northwest Pediatric Critical Care; Dr. Joe Frankhouse of Legacy Medical Group; Dr. Arvin Gee of Pacific Surgical; Dr. Jennifer Kearsley of Cascade Physicians; Dr. Lewis Low of Legacy Health; Dr. Cameron Luck of The Children’s Clinic; Dr. Malcolm McAninch of Greenfield Health; Mady Murrey, R.N., of Randall Children’s Hospital; Dr. Opher Nadler of Northwest Acute Care Specialists; Dr. Doug Renouard of Broadway Medical Group; Jay Rosenbloom of Pediatric Associates of the Northwest; and Dr. Greg Saunders of Legacy Medical Group-Fisher’s Landing.
Chris can be reached at [email protected].
