Partnership Advisory Group Discusses Quality, Scope, and Governance at Fourth Meeting

December 10, 2019
PAG Dec 10

Advancing the quality and scope of care available in southeastern North Carolina, ensuring local control of decisions, and finding ways to lower costs were among the goals discussed during the fourth meeting of the New Hanover Regional Medical Center (NHRMC) Partnership Advisory Group on Thursday, December 5.

The committee of 21 area citizens has been tasked with exploring options for NHRMC that could include a restructuring and/or a range of partnership models to help NHRMC meet the needs of the area’s rapidly growing population and adapt to changes in the healthcare industry.

At their most recent meeting, the group completed their initial review of the 10 goals and objectives that will be used to develop questions for a request for proposals (RFP) that will be issued on behalf of New Hanover County, which owns NHRMC.

The goals discussed Thursday included:

  • Driving quality of care throughout the continuum. This goal focuses on providing consistent high-quality care and coordination through every step of a patient’s care. This includes how information is shared between health care providers in different settings, from primary care practices, to hospital-based physicians, and post-acute care facilities such as nursing homes. Members of the Advisory Group talked about the increasingly important role of advanced care providers and nurses as part of this effort to cost-effectively manage patient care. They also discussed the cost of technology and data systems to monitor quality metrics and use them to make improvements.
  • Improving the level and scope of care. This goal calls for protecting and strengthening the services available and accessing new and innovative technologies. Priorities include keeping all existing services and adding more so area residents don’t need to leave the area for specialized care. It also means ensuring that all residents have access to these services, regardless of ability to pay. The group talked about the importance of innovation and how NHRMC can accelerate the use of new therapies locally.
  • Investing to ensure long-term financial security. Gaining access to capital and resources to sustain growth and allow NHRMC to withstand cuts to reimbursements while adapting to changes in the healthcare industry is the focus of this goal. It speaks, in part, to NHRMC’s ability to fulfill its capital plan, which includes the construction of new facilities to serve area residents. Construction projects on the horizon include a new emergency department to replace the one on the Cape Fear campus, a new hospital in the Scott’s Hill area with a focus on orthopedics, and additional locations for outpatient care in the region. The group discussed how investments in new services and technology are critical to meeting the needs of area residents but come with risk as reimbursements are being cut.
  • Strategic positioning. NHRMC’s position in the region is the focus of this goal.  The Advisory Group talked about strengthening NHRMC’s relationships with other hospitals and health providers and bringing opportunities for NHRMC to expand. The group discussed whether a potential partner would consider moving or growing key services in this region, expanding the economic base and making Southeastern North Carolina more of a destination for specialized healthcare.
  • Governance.  This goal focuses on establishing the most effective form of governance to preserve and advance local interests. Objectives include maintaining local control of hospital-based provider contracts and preserving existing relationships with independent practices.

Advisory group members also discussed their changes to the first five sets of goals and objectives reviewed at the previous meeting. Those included:

  • Improving access to care and wellness. The advisory group added objectives around increasing access to home care, promoting cost transparency, and improving access to women’s and geriatric services.
  • Advancing the value of care. Members added clarifications around reducing the cost to deliver care while maintaining and improving quality.
  • Achieving health equity. Advisory group members listed expanding the reach and number of community healthcare workers to improve the health in underserved communities as an important objective. They also called for further engaging employees in the organization’s efforts to achieve health equity through education and training.
  • Engaging staff. Protecting the benefits and jobs of those who work in the NHRMC system and reducing turnover were among the priorities for the advisory group. They also added objectives around developing careers in healthcare through training for local residents and developing plans specific to nurse recruitment and other key shortage areas.
  • Partnering with providers. Advisory Group members discussed ways to preserve and strengthen the relationships physician and advanced practice providers have with NHRMC. They added objectives around research, adding specialized services, and supporting and aligning with providers to improve healthcare services in the community.

The cost of care was raised as the group discussed advancing the value of care. Members of the Advisory Group said they want to ensure any path forward would continue the work NHRMC has been doing to bring costs down while improving the quality of care. Discussions touched on the success NHRMC has had managing costs for the 19,000 patients who are a part of its Accountable Care Organization (ACO). By carefully tracking and guiding care for those patients, NHRMC’s ACO achieved the highest level of quality scores and saved Medicare $5.3 million in 2018.

Expanding that effort to more patients is both desirable and necessary as more reimbursements will be tied to “value” in the future.  Value contracts pay health systems a flat fee per person, rather than paying for each medical service they need, regardless of how complicated their conditions. Government insurance providers are moving in that direction, as are the private insurers. Blue Cross Blue Shield NC is requiring NC health care systems to enter into value contracts as their contracts come up for renewal. Many of the state’s largest health systems are already working within these contracts and NHRMC’s contract comes up for renewal in 2020.

As this shift happens, the old model in which mergers could lead to higher costs becomes less relevant, because everyone needs to lower costs to succeed.  The advantage for larger health systems will come from their ability to invest in the technology and expertise to manage the population’s health risks and keep per person expenses down.

Advisory Group members talked about shaping RFP questions to learn more about how organizations could help NHRMC manage expenses and make care more affordable for area residents.

The process of developing the RFP questions has begun based on the goals and objectives outlined. The Advisory Group will begin discussing them at their meeting on December 19.  The RFP will be just the beginning of soliciting information from organizations interested in partnering with NHRMC. The Advisory Group will be able to seek clarifying information from respondents and pose follow-up questions after responses have been received.

After issuing the RFP, which will be posted on the website, the Partnership Advisory Group will take two months to evaluate NHRMC’s options for remaining independent and talk about different governance models.