Description

The move from volume- to value-based healthcare started a dialogue among Colorado's Western Healthcare Alliance (WHA) members. WHA is a network of 29 healthcare organizations throughout Colorado and Utah that aims to improve regional healthcare through combining resources. They knew something had to change in order to improve population health and assure cost-effectiveness of local delivery systems.

WHA launched the Community Care Alliance (CCA) in 2015. Through services and educational resources, CCA helps member healthcare facilities increase their value-based delivery of care and create medical homes for their patients.

With the goal to help members aggregate their rural populations and gain experience in population health management, the CCA created 2 ACOs: the Rocky Mountain ACO and the San Juan ACO. With funds from the Centers for Medicare and Medicaid ACO Investment Model, CCA supported care coordination activities, technology resources, practice infrastructure, and provider engagement efforts for members.

The following healthcare facilities are represented on the CCA board of directors, but there are over 27 members of CCA representing over 50 practices:

• Aspen Valley Hospital
• Delta County Memorial Hospital
• Grand River Health
• Gunnison Valley Health
• Montrose Memorial Hospital
• Rangely District Hospital
• Memorial Regional Health
• Valley View Hospital
• Pioneers Medical Center

By way of the Valley View Hospital, the CCA was originally partially funded through a 2014-2016 FORHP Rural Health Network Development grant. Matching funds were provided by WHA members who elected to reinvest profits from Healthcare Management, a WHA subsidiary. CCA has established a fee structure for its hospital and practice participants in order to continue the Alliance's work.

Services offered

The CCA infrastructure offers services to meet various needs of members and their healthcare partners:

• Clinically Integrated Network – A contracting platform in which hospital providers engage with insurance payors in value-based payment initiatives. Participants must meet the requirements of a value-based environment in order to receive incentives.
• Practice Transformation – As a Practice Transformation Organization, CCA offers facilitation to specialists through practice-specific outreach and assessment, as well as the Transforming Clinical Practice Initiative (TCPI).

• Care Coordination Training and Facilitation – Assists local care coordinators, medical providers, and care teams in implementing care coordination and team-based care to improve patient outcomes.
• Virtual education sessions – CCA facilitates virtual care coordinator trainings as well as monthly networking and learning collaboratives to instruct members on the elements of care coordination, ACO requirements, quality improvement, and other services available through CCA.

• Data Analytics and Predictive Modeling – A platform from which medical practices can pull reports and analyze patient data. With the information, providers can assess beneficiary needs and sets improvement goals and strategies with specific targeted interventions.
• Quality Improvement Monitoring and Reporting – Offers performance improvement initiatives and supports reporting on quality measures. Helps to facilitate TCPI's data use and reporting for quality improvement.
• Network Support – Leverages existing relationships across the spectrum of services, helping to build bridges between participating members to share resources and ideas to better meet the needs of the members' patients.

Results

• A total of 43 organizational members have received educational, networking, and technical assistance by being a part of CCA's ACOs. Both ACOs consistently score above the national average for quality.
• All CCA participants have seen an increase in the use of care coordinator-related Medicare codes and reimbursement for services.
• Member healthcare communities have increased collaboration among independent providers, clinics, and local hospitals on community health initiatives, patient transfers, and appropriate access education.
• CCA has seen an increase in the level of team-based care as a result of members accessing their data analytics platform.
• Member hospitals are experiencing a decrease in emergency room utilization. The ACOs are constantly monitoring hospital readmissions and utilizing care coordination efforts to educate patients on the appropriate use of the ER.
• Over 22,000 Medicare beneficiaries have been introduced to care coordination, leading to a decrease in emergency room visits, an increase in overall health, and lower medical costs.
• More recently, a group of local employers in a rural community have collectively contracted with CCA to improve the health of their self-funded health plan covered lives population.

Challenges

CCA has overcome these difficulties while helping their members try to improve population health in their local communities:

• Rural practices often have limited resources preventing them from hiring care coordinators.
• Integration of clinical data: There are currently 14 EMRs used by participants, complicating the integration of clinical data and adding to the complexity of quality reporting.
• Providing education and resources to rural, geographically disparate communities: CCA created numerous toolkits and creative educational opportunities to ensure participants have the tools and skills necessary to be successful.

Replication

The CCA recommends the following key principles:

• Paint the global vision for those involved: Express what you as a network are wanting to achieve, formulate the options of how to accomplish those goals, and articulate the perceived benefits for the patients and community members being served. Repetition is key.
• Let the medical community lead: Success is often linked to provider engagement within networks; utilize a medical champion to communicate a vision to providers and secure their involvement. Network leaders must stress the importance of clinician engagement to involved clinicians.
• Members must hold each other accountable: Success cannot rely on the efforts of a few members; All members must be involved. All members should actively engage in care coordination, quality improvement and practice transformation work.
• "Don't throw effort after foolishness": Value-based transformation is a moving target and networks and members must be prepared to make corrections along the way. The membership should work together to identify areas of improvement and strategies to correct and maintain forward progress.

Contact Information

Connie Mack, Executive Director
Community Care Alliance
970.986.3675
connie.mack@communitycarealliance.com