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Vanderbilt Medical leads push for statewide health care network

Holly Fletcher
USA TODAY NETWORK – Tennessee
Vanderbilt University Medical Center is leading a push to bring independent hospitals from around the state under a single umbrella network that would reshape access to care around Tennessee.

Vanderbilt University Medical Center is leading a push to bring independent hospitals from around the state under a single umbrella network that would reshape access to care around Tennessee.

Nearly five years in the making, the statewide Vanderbilt Health Affiliated Network would be unprecedented in its scope, reaching from Memphis to Johnson City — and beyond.

Leaders of VHAN call it an "integrated clinical network," but the initiative's goals are loftier than the wonky industry term might suggest and involve lifting the standard of care in a state that consistently ranks toward the bottom when it comes to health outcomes around the country.

The idea is to rethink how people access care, help employers manage costs, improve clinical outcomes and improve the health of the notoriously unhealthy state and region.

"We're busy doing this. We've been very quiet about it," said Mark Cianciolo, VHAN's executive director, noting more than 100 jobs have been created in Nashville as part of the VHAN expansion.

The physician-led network, which has 51 hospital affiliates in five states under 11 health systems, underscores the importance of ingenuity and partnership between traditionally siloed — and sometimes rival — entities as the health care industry tries to modernize the infrastructure that provides and tracks care, experts say.

Mark Cianciolo

Dr. C. Wright Pinson, CEO of Vanderbilt Health System, said the network takes advantage of "informatics," or big data, to engage with patients and track results on a large scale to better provide care and improve well-being across the board. VHAN includes urgent care and walk-in clinics, physician groups and hospitals, in addition to digital components such as apps and a website, mysouthernhealth.com, to better bring patients into the decision-making that leads to better health.

"Historically, if we think about how well we have coordinated care, it actually never has been all that good," Pinson said. "You might say this whole process is trying to deliver improvements over what we have done for decades.”

Solutions

The decision in 2012 to launch VHAN with four founding affiliates along the Interstate 65 corridor — VUMC, Maury Regional Medical Center, NorthCrest Medical Center and Williamson Medical Center — came at a pivotal moment in health care as the industry began to confront how to change business models so that reimbursements to hospitals are based more on positive health outcomes than the sheer quantity of services provided.

Williamson Medical Center is one of the four founding health systems in the Vanderbilt Health Affiliated Network.

Employers have long been struggling with ever-rising health care costs and the Affordable Care Act hastened the speed at which consumers picked up more of the costs.

The urgency to address those realities was felt stronger in few places than Tennessee, one of the unhealthiest states in the nation. It is a problem that increasingly worries public health, government and business leaders.

"If we don’t fix that problem, five or 10 years from now we’re not going to be the place that all these companies come to decide where to put their headquarters or a new location," Cianciolo said. "I’m passionate about the idea that the long-term economic viability of Tennessee is driven by a strong education system, a strong business and a strong health care community."

VUMC leaders met with a variety of employers to find out what they wanted from health care providers and in benefits, Cianciolo said. Many employers, particularly those with large footprints, want to know that employees have access to quality, local health care.

VHAN is both a competitor and a partner to insurers as it tries to win over employers and have them join the network, Cianciolo said.

Joining the network gives employers access to all the facilities and providers affiliated with VHAN. There are more than 110,000 people insured in the network, with a goal of 1 million by 2020.

Dr. C. Wright Pinson

The network's first insurance products are offered by Aetna, which started talking with network leaders in the early days. But Cianciolo said VHAN has "multiple arrangements in the works," for commercial and Medicare Advantage products.

"You may go, 'Wow, they're working with this payor and this payor. How are they doing that?" Cianciolo said. "But to make an impact the network has to be insurer agnostic."

Keeping it local

All health care, like politics, is local, said Pinson, and it became clear to medical center leaders that finding ways to make health care easier to navigate in all corners of the state was essential to the vitality of the future.

Member hospitals are, at this point, overwhelmingly not-for-profit. Sumner Regional Medical Center, owned by Brentwood-based LifePoint Health, is the only for-profit member.

The health systems range from behemoths, such as Baptist Memorial Health Care out of Memphis and Mountain States Health Alliance in Johnson City, to single facility systems including NorthCrest in Springfield and Jennie Stuart Medical Center in Hopkinsville, Ky.

Sumner Regional Medical Center in Gallatin

VHAN extends into four bordering states via Baptist Memorial and Mountain States. It's got a presence in most regions of Tennessee, with the notable exception of the Interstate 75 corridor between Knoxville and Chattanooga.

Joining the network gave Cookeville Regional Medical Center, which operates two hospitals, additional access to resources and group contracting without signing away ownership, CEO Paul Korth said. There's now an outpatient children's clinic in Cookeville that provides services the area didn't have, which Korth said often cuts parents' drive time in half.

Interactive: Network reaches across Tennessee

"They want us out here in the affiliated hospitals to take care of everything we can take care of," Korth said. "It's worked very, very well."

The endgame is to provide access and keep access local while streamlining the process for people to reach the specialty care they need, VHAN leaders said.

The network bears the Vanderbilt name because of the brand and reputation the academic medical institution brings, but VHAN can only be successful with strong community and regional partners, Pinson said.

"The sale, if you will, to get people to participate in this network has become easier and more people are approaching us de novo than actually we’re going out to at this point," Pinson said. "There are people I’d like to have in this network — but I would say there are entities I haven’t specifically gone after are now asking to be considered."

VHAN is also advising entities in neighboring states on setting up similar systems, said Pinson, adding the systems could link in the future.

The challenges related to managing costs, people's access to care and health status are not local to Tennessee but are felt by the entire Southeast, executives of VUMC and VHAN said in interviews.

"You might say, 'You’re creating a giant and it will be impersonal.' Well, no. What we have is impersonal," Pinson said. "If we could get the system to function and communicate with the different parts that is so much better for patients and their families. We’re just trying to take what we already have and organize it."

The rise of collaborations

Daniel Steingart, senior analyst at Moody's Investors Service, said VHAN highlights how different types of health care entities are partnering and collaborating to find solutions. Provider groups and insurers are testing new models of partnerships that rethink the traditional relationship, which can be contentious, particularly when it comes to reimbursement.

"It’s a refreshing way for insurance companies to interact with the provider community instead of having (annual) or every two or three year negotiations that end up being in the newspaper," said Jayna Harley, Aetna's network chief for Tennessee and Arkansas.

Similar initiatives have been attempted before. Seven hospitals around Los Angeles formed a network with Anthem, called Vivity, that shares some characteristics with VHAN. Both include academic hospital expertise and community hospitals, but VHAN stretches across the state to stitch together a rural and urban network, notes Moody's.

The Vanderbilt Health Affliated Network

A fundamental difference, however, is that an insurer — not providers — established and owns Vivity. Half of VHAN's board of directors are clinicians.

There are some other provider-led networks across the country that appear to be leading the partnerships, said Jason Little, president and CEO of Baptist Memorial Health Care in Memphis, a member of VHAN. The Integrated Health Network of Wisconsin is led by providers and has a contract with UnitedHealthcare, making it, according to the Baptist Memorial team, more similar to VHAN.

Jason Little

"Our goal, truthfully, is not to replicate but to really innovate," Little said. "That’s what we’re trying to do."

Some employers jumped onto the idea of the network quickly while others wanted to see results and let it mature before coming into the network, Harley said. There are 70 employer health plan customers, with a renewal rate, so far, above 90 percent.

Forging the collaboration does not come without hiccups, such as technology.

VHAN, under David Posch, associate vice chancellor for population health, is working on software for a health information exchange that essentially links the existing electronic medical record systems so hospitals and clinics can share data. Previous efforts to establish an exchange in the Nashville area have failed. VUMC received a $28 million grant last year to help with that process.

"They seem to be sort of limitless in their approach," Harley said of the network. "There are not barriers. They are very willing to knock down any barrier that comes up and forge ahead. It hasn’t been easy as you can imagine.”

Reach Holly Fletcher at 615-259-8287 or on Twitter @hollyfletcher.