Moda Health Joins Hospitals in Transforming Health Delivery

The Population Health Alliance has brought together hospitals from across the state -- Asante, Bay Area, Mid-Columbia, OHSU, Salem Health, Sky Lakes and St. Charles -- along with Moda Health, the only insurer participating in this endeavor.

Moda Health has joined forces with hospitals from throughout the state to transform the delivery of healthcare and expand its reach

As one of the leading forces behind the Population Health Alliance – a partnership of seven hospital systems throughout Oregon – Moda has primed itself to take healthcare in a new direction, while, at the same, reducing cost and improving care. The Alliance becomes operational next January.

Larry Mullins, president of Samaritan Health Services, which has five hospitals under its wing, was approached to become part of the Alliance, but decided to hold off. “We prefer to wait and see what develops,” he told The Lund Report. “I felt at the time it wasn’t a good direction for us and didn’t fit our model right now.”

Aaron Crane, formerly the chief financial officer of Salem Health, has been tapped to lead the Alliance endeavor and has recruited Dr. Geoff Swanson who spent 15 years focused on healthcare leadership at St. Luke’s Regional Medical Center, as chief medical officer.A director of technology and analytics, Melissa Davies, is also on board.

Initially, Crane was loaned by Salem Health to get the project off the ground last year and began working out of Moda’s offices in downtown Portland. “I’m not planning to go back to Salem Health; I’m here for the long haul. I’m very excited and optimistic about doing this,” he told The Lund Report.

The Alliance isn’t unlike the goal of the Oregon Health Policy Board, to replicate the coordinated care model in the commercial marketplace. And, its primary tenets appear closely aligned – managing and coordinating care, shared responsibility by the providers and patients, measuring performance and paying for outcomes, price and quality transparency and sustainable costs. The statewide purchasing pools – the Oregon Educators Benefit Board and the Public Employees Benefit Board – are already moving in that direction.

Felisa Hagins, political director of SEIU 49, made it quite clear at yesterday’s Health Policy Board meeting that the commercial market needs to move in this direction because, she said, “I have no faith that the federal government will work this out anytime soon.”

The Alliance is comprised of seven hospital systems – Asante Health, Bay Area Hospital, Mid-Columbia Medical Center, Oregon Health & Science University, Salem Health, Sky Lakes Medical Center and St Charles Medical Center. Together they have 52,000 employees and represent 3.5 million patient visits, including inpatient admissions, and outpatient and emergency room visits, all of which will become part of this new approach.

Physicians are at the core, and a 14-member quality and health management committee has been organized to help lead this effort, which held its kick-off meeting last December. Its members includes:

  • Dr. Jeff Absalom, internal medicine, St. Charles Medical Group
  • Dr. Mary Engrav, emergency medicine, Moda Health
  • Dr. Stephanie Halverson, hospital medicine, Oregon Health & Science University
  • Dr. Ian Loewen-Thomas, family medicine, Salem Clinic
  • Dr. Neal Mills, family medicine, Moda Health
  • Dr. Lee Milligan, emergency medicine, Asante Health
  • Dr. Christopher Morgan, internal medicine, Asante Health
  • Dr. William Moriarty, hospitalist, Bay Area Hospital
  • Dr. Grant Niskanen, family medicine, Sky Lakes Medical Center
  • Dr. John Nunes, OBY/GYN, St. Charles Medical Group
  • Dr. Judy Richardson, family medicine, Mid-Columbia Crest Clinic
  • Dr. Mary Tanski, emergency medicine, Oregon Health & Science University
  • Dr. Tom Yackel, internal medicine, Oregon Health & Science University, and
  • Dr. Ralph Yates, family medicine, Salem Health, Willamette Health Partners

These physicians will play a key role in setting strategy for the alliance, establishing priorities that drive care management and clinical transformation. They’ll play a key role in utilizing clinical, financial and claims data to identify opportunities to improve care, while managers and other clinicians will receive training on best practices to manage patients with chronic diseases such as diabetes. Metrics will be defined to track the success and adjust protocols as necessary based on results.

To change the landscape, the Alliance has engaged Evolent Health, based in Arlington, VA., to develop the technology platform, using the claims data and electronic medical records to do risk stratification and develop and manage care plans working with the physician leaders, Crane said. All the health records being analyzed have privacy protection with a HIPAA agreement firmly in place.

“Evolent has been successful in other markets with a variety of clients working with physician leaders, and we’re going to put their ideas to use and make it work,” Crane said. “They have the data to analyze the patient population and, at the end of the day, we need to improve how money is being spent to produce better health at a lower cost.”

Once the Alliance goes live in January, these hospitals should see fewer people using their emergency rooms or being readmitted to the hospital, Crane added. Later, other hospital systems will be invited to join the Alliance, but not the independent medical clinics.

Moda’s Involvement

Moda became involved because its leadership was looking for strategies around population health and had an affinity to work with this group. Its spokesman, Jonathan Nicholas told The Lund Report that

Moda now has 13 companies under its umbrella and calls itself a “House of Brands” rather than a “Branded House.”

Calling the Alliance a platform, not a health plan, Nicholas said Moda became involved after learning that many of its partners were investigating a similar series of initiatives. “By harnessing our energies to a single wagon, we hope to accelerate the process of improving care,” he said. “Moda is always looking for new opportunities, either by founding or acquiring companies, to continue our commitment to drive down the cost of healthcare by transforming the way it is both provided and paid for throughout the communities we serve. Our demonstrated successes to date in Oregon, in Washington and in Alaska have made clear that people like the way we are making health simple. That’s why we made the decision this year to plant our flag in California. Any why California is going to be seeing a lot more of us in the years ahead.”

Diane can be reached at [email protected].

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