Population Health Management

In 2014, Frederick Regional Health System, Meritus Health, and Western Maryland Health System, three locally based non-profit health systems with long histories of community service, formed a system-wide affiliation to create the Trivergent Health Alliance, LLC. The three key objectives of the Alliance are to improve the health of the population served by the three hospitals, improve the quality of care rendered by the hospitals and to reduce the cost of healthcare provided as embodied in the Management Services Organization (MSO). A subsidiary, Trivergent Health Alliance MSO, LLC, was created to oversee six key service lines for the three hospitals: supply chain, revenue cycle, laboratory, pharmacy, information systems, and human resources.

 

Representatives from the three partner health systems came together again in March 2015, in cooperation with Trivergent Health Alliance, with the common goal of transforming our local health care delivery system through the development of a Regional Care Transformation Partnership. They examined leveraging best practices existing at each hospital, shared lessons learned, and identified resources to be used in an efficient manner to achieve better, more cost-effective outcomes. The partnership would facilitate collaboration to improve patient experience; and identify services and programs needed to benefit the health and wellness of the population served.  During the second half of 2015, the Partnership developed a Regional Care Transformation Plan based on prevailing patient and population health needs to improve care coordination for those with behavioral health conditions (including substance abuse) and patients with chronic conditions requiring complex care management.  In June of 2016, the Regional Partnership's Care Transformation Plan was awarded funds from the HSCRC to implement the program.   

 

Frederick Regional Health System, Meritus Health, and Western Maryland Health System, through the Regional Care Transformation Partnership, are committed to meeting the state’s all payer goals by implementing evidence based, scalable, sustainable initiatives that improve the health and health care of the patients served, as well as the population at large within our tri-county service area (Washington, Allegany and Frederick counties). Our regional partnership was founded with the following overarching objectives:

 

 

  • To initially focus our care delivery transformation by targeting opportunities where we can make an important difference in a relatively short period of time.

 

  • To build a highly collaborative regional model, with customized local models of care, built on current ‘best practices’.

 

  • To design our interventions based on a deep understanding of health status and needs of region.

 

  • To focus our clinical interventions on improved patient outcomes, economies of scale, financial savings and capabilities.

 

  • To share resources to build a regional infrastructure that includes standard tools and systems, regional excellence in clinical staff training that focuses on patient-centered care, standard treatment protocols, efficacy and quality.

 

  • To use data/analytics to make informed decisions and develop key metrics to monitor and evaluate success.

 

  • To identity financial mechanisms and arrangements that will ensure sustainability of the model.

 

  • To identify needed initial and ongoing investments.

 

  • To provide strong leadership that fosters a culture of innovation and change.

 

 

To identify the care models needed to address the health care priorities for our community, we used a data driven approach to identify the current health status and resource needs of the most vulnerable as well as the entire population in our region, in order to determine what models would best address the greatest health care needs. By reviewing the Community Health Needs Assessment, Alliance hospital specific data, State and Regional data we determined that the Regional focus will be:

 

  • Behavioral Health: This includes all BH diagnosis, with the top 5 being Depression, Anxiety, Bipolar, Psychosis and Substance Abuse

 

  • High utilizers of inpatient services who may benefit from Complex Care Management. These patients have 3 or more Inpatient/Observation (OBS) discharges in a year with diagnoses of diabetes, cardiac disease including Congestive Heart Failure (CHF), and respiratory disease including Chronic Obstructive Pulmonary Disease (COPD)and anticoagulation patients.

 

  • High Utilizers of Emergency Department (ED) Services: These patients have 6 or more ED visits in a year.

 

TIMELINE

May 2015

Trivergent awarded planning funds to create a Regional Care Transformation Plan

 

June-November 2015

Regional data analysis was conducted to understand and identify the targeted high utilizer populations, define interventions needed, and compose the Implementation Funds RFP Grant Proposal response.

 

December 2015

Regional Care Transformation Implementation Grant Funds RFP response was submitted to HSCRC.

 

February-March 2016

Grant applicants received clarification request from HSCRC, response was submitted on behalf of Trivergent Health Alliance

 

April-May 2016

Response was reviewed and panel interviews were conducted with applicants.

9 Implementation Grant Regional Partnership awards totaling $30.5M were recommended to the HSCRC for approval. 

 

June 2016

Trivergent Health Alliance Regional Partnership received award notification for $3.1M, the funds will be divided equally among the three partner hospitals

 

NEWS LINKS

May 2015

Trivergent Health Alliance Receives Grant for Population Health Initiative

 

WESTERN MARYLAND – Trivergent Health Alliance was recently awarded a $400,000 regional planning grant from the Health Services Cost Review Commission or HSCRC and Maryland’s Department of Health and Mental Hygiene or DHMH. The grants will help in the development of regional partnerships for health system transformation in support of the state’s new all-payer model.

 

The Alliance’s proposal was submitted on behalf of Western Maryland Health System, Frederick Memorial Hospital and Meritus Medical Center.

 

Future work will focus on patient populations, including those with multiple chronic conditions and frail elders, with attention on reducing risk factors, improving integrated care and achieving cost savings. According to HSCRC and DHMH, the overarching goals are to create the right partnerships to assist hospitals with the new all-payer model and achieve the triple aim of enhancing patient care, improving population health and lowering total health care costs.

 

Trivergent Health Alliance’s award was one of eight given in the region. Funding will be allocated by HSCRC-approved rate increases for the hospitals working in conjunction with partner organizations.

 

 

February 24, 2015

Five Maryland-Based Health Systems Come Together to Form “Advanced Health Collaborative”

http://www.adventisthealthcare.com/about/news/2015/five-maryland-health-systems-form-advanced-health-collaborative/#.V31tHTXImjM

 

February 27, 2015

MD Health Systems Collaborate for Population Health Management

http://healthitanalytics.com/news/md-health-systems-collaborate-for-population-health-management

 

February 28, 2015

Maryland systems team up for population health

http://www.modernhealthcare.com/article/20150228/MAGAZINE/302289950