1. A Clinically Integrated Network

2. Who is SignalHealth? Unique corporate identity
Parent organization is Virginia Mason Memorial
Formed in 2011
Participation allows us to contract for and on behalf of our members
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3. Who are we? Diverse membership 87 unique practices
315 unique physicians
104 unique midlevels
6 skilled nursing facilities
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5. What is clinically integrated?
American Hospital Association:
“Clinical integration is needed to facilitate the coordination of patient care across conditions, providers, settings, and time in order to achieve care that is safe, timely, effective, efficient, equitable, and patient-focused. To achieve clinical integration we need to promote changes in provider culture, redesign payment methods and incentives, and modernize federal laws.”
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6. What is clinically integrated?
Advisory Board
It’s a specific type of legal arrangement that allows hospitals and physicians to collaborate on improving quality and efficiency, while remaining independent entities.
In a clinical integration organization, physicians collectively invest in IT infrastructure, such as disease registries and clinical performance management systems, as well as funding staff dedicated to performance improvement. 
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7. What is clinically integrated?
1996: FTC and DOJ
Clinical Integration (CI) is an active and ongoing program to evaluate and modify practice patterns by the CI network's physician participants and create a high degree of interdependence and cooperation among the physicians to control costs and ensure quality
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8. DOJ and FTC Expectations for CIN’s
Establishes mechanisms to monitor and control utilization of healthcare services that are designed to control costs and ensure quality of care.
Selectively chooses CI network physicians who are likely to further these efficiency objectives.
Utilizes investment of significant capital, both monetary and human, in the necessary infrastructure and capability to realize the claimed efficiencies.
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9. Why all the fuss?
Collective bargaining by physicians that compete with each other is considered anticompetitive and is prohibited except when physician networks are: financially or clinically integrated.
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10. What are the minimum requirements?
Collect, analyze, and understand performance data on quality and cost, for episodes of care, and for total cost of care for populations
Manage clinical quality and cost performance across diverse settings for episodes of care, and/or for populations
Govern the whole operation
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12. Physician Autonomy
“ At Virginia Mason… we understand that healthcare is impeded not facilitated by the notion of physician autonomy.”
~Dr. Gary Kaplan, MD
CEO Virginia Mason
January 11, 2014
Modern Healthcare
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13. Yakima County
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14. 2016 Community Needs Health Assessment
Yakima County is composed of primarily rural communities (14 cities and towns) in Central Washington
Spanning 4,296 square miles
65% Medicare/Medicaid payer mix
Total current population for Yakima County as of July 1, 2015 is 248,830
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15. 2016 Community Needs Health Assessment
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16. 2017 County Health Rankings
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18. Reality…
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20. This should be easy, right?
Presumptions:
Patients and their families are invested in their own health.
Patients tell their story fully to their providers.
Patients do what they say they’re going to do.
Palliative and hospice care are appropriate interventions/options for specific populations.
Patient actively participate in their medical decision making.
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22. What are the operational priorities?
Quality
Care coordination
Nurses
Social workers
Community care connector (ALTC)
Utilization management
Medical management
Pharmacy management
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23. 2016 Lessons Learned Small changes and actions make a big difference
Patients are first
Quality matters
We are a learning organization, building on our internal strengths and differences
Teamwork
"the perfect is the enemy of the good“ …Keep moving.
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25. 2017 Contracts Medicare Advantage
Virginia Mason Memorial High Value Plan (HMO)
Puget Sound High Value Network
Health Alliance Northwest Employees
Molina Medicaid
More than 10,000 lives under contract
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27. Case studies Diabetic with prescription she couldn’t afford
Hoarder with congestive heart failure
Housing over provider visits
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29. Question and Answer
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30. Thank you!