• Partnering for Population Health

    An interview with Patricia Maryland Aug 10, 2015

    No matter how big a health system is, it will need strategic partners to effectively deliver on population health management.

    Patricia Maryland, president-healthcare operations and COO, Ascension HealthSt. Louis-based Ascension Health, with 1,900 sites of care in 23 states and the District of Columbia, is the largest not-for-profit health system in the United States-but it is not big enough to succeed on its own.

    "To deliver a competitive product in a population health environment you will have to provide access both geographically and across the continuum of care. In light of this, it's going to be very difficult to create long-term sustainability without partnering," says Patricia Maryland, Ascension's president-healthcare operations and COO. "Partnership is going to be the name of the game going forward."

    One example: Together Health Network, a clinically integrated network that was formed by two of the largest health systems in Michigan-Ascension Health and Trinity Health Michigan-and their physician partners across the state.

    Clinically integrated networks are legal arrangements recognized by the Federal Trade Commission in which independent physicians and hospitals can jointly negotiate contracts with insurers without running afoul of antitrust regulations. "We aim to reduce the per capita cost of care and improve the health of the population served, while providing an exceptional experience for our patients as well as our providers," Maryland says.

    Preparing to Partner

    Before joining Ascension, Maryland spent 15 years at the physician-led Cleveland Clinic Foundation, where she learned how health system administrators and physicians can work together effectively. "Not having the physicians at the table partnering with you is a huge mistake," she says.

    Maryland also came to understand cross-system needs through a variety of roles. When she first came to Ascension, she served as president of a large hospital system and then the regional COO for a 16-hospital system. In early 2008, Maryland was asked to take on one of Ascension's most challenging assignments: With Michigan's economy imploding and Detroit's unemployment rate headed toward 30 percent, she was named president/CEO of Michigan's St. John Providence Health System and the state's ministry market leader, with responsibility for 24 percent of Ascension's assets.

    In 2012-which was one of the most economically depressed times in Michigan history-St. John Providence ended the year with a net income of nearly $59 million, while providing more than $155 million in charity care and other community benefit programs. The next year, Maryland was promoted to serve on Ascension's senior leadership team at the national level.

    Together Is Better

    Partnering with Trinity in Michigan made sense, she says. Both systems were already top-quartile performers in the pay-for-performance program of Blue Cross Blue Shield of Michigan (BCBSM), the state's largest private insurer. Maryland approached Trinity's top executive: "I said, 'Think about how we complement each other. We have complementary geographies; we are both moving toward population health management, and we both have a pretty aggressive pace of change.'"

    Collaboratively, the entities launched Together Health Network in 2014 and, shortly thereafter, BCBSM announced ConnectedCare, a Medicare Advan­tage narrow network plan in partnership with Together Health in eight Michigan counties. Initial enrollment exceeded expectations, and Together Health is now in discussions with other payers to develop narrow network products.

    While Maryland is enthusiastic about the Together Health Network's clinically integrated model, she knows this form of partnership may not be the best option in all markets. "There are multiple approaches, and we are testing and piloting several," Maryland says. "The key here is tracking the results to see what kind of impact we are having. Is this making a difference Is this moving us further toward being able to really change and improve the way we are delivering care to our patients?"

    Patricia A. Maryland, DrPH, is president-healthcare operations and COO, Ascension Health, St. Louis.

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