Archives: Locations

Population Health Communities

Rainier Health Network

Established in 2013, Rainier Health Network was Washington state’s second ACO and the first in the South Puget Sound area, with a vision to become the premier network in the region. The network primarily serves King, Pierce and Kitsap counties, managing more than 230,000 lives with over 5,000 providers.

Today, Rainier Health Network has evolved beyond the CMS Medicare Shared Savings Program to include all types of health plans from commercial payers to employer-direct. We have also expanded our provider membership to ensure a comprehensive network across our geography.

Quality Highlight

Four standing committees on Rainier’s board manage the development of system improvements to help the ACO reach its goals. In 2015, the network earned its first MSSP payout of nearly $3 million with a Quality Composite Score of 87%. With continuous improvements, RHN in 2019 received an outstanding quality score of 95% and earned over $6.7 million in Medicare Shared Savings.

Arizona Care Network

Serving the Phoenix metro area, Arizona Care Network (ACN) is a joint venture of Dignity Health Arizona and Abrazo Health (a Tenet Health company). In its formative years, ACN operated a Medicare Shared Savings Program ACO (Track 1 from 2013 through 2017; Track 1+ in 2018) and expanded to participate in the Next Generation ACO (NGACO) model, operating the two simultaneously in 2017 and 2018. During that time, the network grew in sophistication, proving its ability to effectively manage risk. In 2019, ACN transitioned its Medicare lives to the NGACO model exclusively, earning gainshare each year. Today, ACN is one of only 41 NGACOs in the country.

ACN has distinguished itself as a high-performing network, exceeding $48 million in total medical cost savings to date across 13 value-based arrangements, including Medicare and Medicaid as well as commercial value-based contracts spanning Medicare Advantage, employer-based plans, individual and family plans, and direct-to-employer agreements.

ACN was named “One of 110 ACOs to Know” the last three consecutive years by Becker’s, the health care industry’s premier business publication, and was recognized by the National Association of ACOs (NAACOS) with their 2019 Innovation Award.

Strategy Highlight

ACN’s Provider Rewards Program (PRP) has always been a popular network benefit for primary care providers participating in ACN’s Medicare models. Since 2015, the organization has dedicated a significant pool to reward PCPs for the hard work associated with value-based medicine, including bonuses for high-risk member visits, annual wellness visits, clinical quality and in-network care coordination. Each year’s incentive program aligns with the clinical metrics and network activities that drive success under the NGACO Model. As such, the PRP is a leading indicator for final NGACO performance.

MercyOne Population Health Services Organization

MercyOne is a connected system of health care facilities and services located across Iowa and neighboring states. Headquartered in central Iowa, MercyOne was founded in 1998 through a collaboration between Catholic Health Initiatives (now CommonSpirit Health) and Trinity Health — two of the country’s foremost not-for-profit, Catholic health organizations. MercyOne has grown into the state’s largest provider of hospital and related health services, consisting of more than 420 care locations.

MercyOne is committed to meeting the health needs of all the communities it serves. Since our inception more than 160 years ago, we have worked to follow the example of our Foundress Catherine McAuley and the religious women who created our hospitals with a special focus on the poor and vulnerable.

The Religious Sisters of Mercy and the Wheaton Franciscan Sisters built the first hospitals, schools of nursing and other health ministries. With little money and no access to modern medical technologies, they cared for the poor and suffering. Their work evolved to become MercyOne, and the foundation our foundresses built has allowed us to become a recognized leader in improving community health.

MercyOne Population Health Services Organization (PHSO)

MercyOne Population Health Services Organization (PHSO) has more than 20 years of experience in population health and value-based contracting. Created to leverage the organization’s experience in population health and to expand into commercial and governmental value/risk-based programs, MercyOne has grown to more than 20 value-based agreements covering more than 320,000+ attributed patients throughout the region.

Since inception, the MercyOne PHSO’s Partnered Provider Network has reduced health care expenditures for Iowans by more than $150 million, working together to improve health, increase patient satisfaction, and lower health care costs for our members and the communities we are privileged to serve.

Care Management Highlight

MercyOne’s nationally acclaimed Care Management program is a core component of MercyOne’s PHSO model. With a continuum of care approach, our team of more than 200 care management colleagues ensures seamless, coordinated care to improve quality, increase satisfaction and contain costs.

All MercyOne clinically integrated networks (chapters) have a single reporting structure for Care Management which allows for standardization and accountability. In the ambulatory environment, this means a cross-functional team of community health workers, health coaches and health coach assistants. While connecting the complex environment of acute and post-acute settings, MercyOne brings together a robust, embedded team of social workers, utilization management, acute case management and post-acute care coordinators.

Care management staff are proficient in MercyOne’s proprietary health coach training, which brings together social determinants of health, shared decision-making and motivational interviewing, helping patients navigate the complexity of health care and chart their path to improved health.

Mission Health Care Network

Based in Chattanooga, Tenn., Mission Health Care Network (MHCN) is a physician-driven clinically integrated network that builds on the strengths of participating providers to improve patients’ health and experience of care, increase efficiency and support provider success in today’s changing health care payment and delivery environments. MHCN supports its participating providers with the tools to manage patients with complex medical needs through care coordination and data analytics.

MHCN directly manages two value-based arrangements, the CHI Memorial Employee Health Plan and the Medicare Shared Savings Program. In addition, the network provides contractual support for additional value-based arrangements through care coordination and data analytics. These arrangements include Medicare Advantage and Patient-Centered Medical Home Quality Partnerships. MHCN also provides population health and care coordination to several CHI Memorial Workplace Health Direct-to-Employer contracts.

Quality Highlight

The network values innovation in improving quality and efficiency of care, and quality performance has been a key strength. Through its collaboration with MHCN, CHI Memorial has been able to achieve 4.5 STARS for its Medicare Advantage program through Blue Cross Blue Shield of Tennessee. For performance year 2018, MHCN achieved an MSSP Quality Score of 93.2%, above the ACO national average. The score was broken out into four domains:

Domain Domain Score
Patient/Caregiver Experience 94.38%
Care Coordination/Patient Safety 100.00%
Preventive Health 89.69%
At-Risk Population 88.75%

CHI Health Partners

CHI Health Partners manages a network of over 4,000 providers throughout Nebraska and southwest Iowa. The organization negotiates and administers value-based agreements with Commercial, Medicaid, and Medicare Advantage health insurance plans on behalf of its provider network. Over 230,000 patients are covered under these value-based agreements. Additionally, the organization provides all management and administrative support to two Medicare Shared Savings Program Accountable Care Organizations — Alegent Health Partners and TPN Health Partners.

Quality Highlight

CHI Health Partners is focused on offering comprehensive, data-driven, coordinated care. In 2017, the Medicare ACOs it manages scored equal to or better than other ACOs in almost all quality performance measures.

CHI Health Partners has dramatically increased its revenue in each of the past three years, and in calendar year 2018 achieved over $40 million in care management and shared savings revenue from its various value-based contracts. CHI Health Partners’ work with CHI Health employees in Omaha also resulted in a 33% reduction in imaging costs, 20% reduction in average length of stay, 17% reduction in medical spending and a 13% reduction in ED visits between 2012 and 2015.

North State Quality Care Network (NSQCN)

Under the guidance of its 15-member Board of Managers, North State Quality Care Network (NSQCN) has continued to grow its network while participating in MSSP. The network includes 159 providers and three hospitals — Mercy Medical Center in Redding, St. Elizabeth’s in Red Bluff and Mercy Medical Center in Mt. Shasta. NSQCN is dedicated to offering patient and provider education for this vast region, which includes Shasta, Tehama and Siskiyou counties.

NSQCN achieved shared savings for its 2018 performance based on high quality scores and excellent stewardship of resources.

Quality Highlight

NSQCN providers have focused on completing annual wellness visits for Medicare patients, encouraging patients to engage in preventive care, identifying patients at high risk for disease and directing those patients to Care Coordination when appropriate. As a result, NSQCN saw a 13% reduction in diabetes admissions, 12% reduction in heart failure admissions, improved glucose control and improved blood pressure control in 2018. The network has also worked to enroll patients in post-acute transitional care to help reduce readmissions.

In addition, NSQCN is proud of its advance care planning campaign, which has included providing materials for patients in physician waiting rooms and hosting monthly “Let’s Talk” classes. The initiative has relieved some of the burden on the network’s providers, while empowering patients to make important end-of-life decisions early.

Valley Integrated Provider Network (VIPN)

Located in Bakersfield, Calif., Valley Integrated Provider Network (VIPN) is a growing network with 859 providers and a strong commitment to care coordination and enhancing disease management. VIPN manages more than 117,400 value-based lives across Kern County and is affiliated with Mercy and Memorial Hospitals.

Strategy Highlight

Since the network was established in 2015, VIPN has been focused on growth, adding new providers and ramping up their care coordination efforts. The network has rounded out its leadership board and governance committees and has worked to develop new employer relationships — all of which help ensure the network is well-positioned for success.

Southern California Integrated Care Network – Ventura County

Southern California Integrated Care Network–Ventura County (SCICN-VC) has grown an impressive 25% in participating providers since 2017. The network manages more than 23,000 lives, and is the exclusive Tier 1 network for the employees of St. John’s Regional Medical Center and St. John’s Pleasant Valley Hospital.

SCICN-VC has joined the other California clinically integrated networks and Dignity Health Medical Foundation physicians from California and Nevada to form the Dignity Health Care Network (DHCN). This new entity is participating in the CMS Medicare Shared Savings Program as a Basic Track, “Level A” Accountable Care Organization (ACO).

SCICN-VC’s Medicare ACO performance in MIPS was positive in both 2017 and 2018. Its 2018 scores improved to 100 points, up from 92.76 points in 2017, earning its participants a positive payment adjustment of 1.68%.

The network also participates in commercial ACO PPO contracts with United Healthcare, Blue Shield, Anthem and the Dignity Health Ventura Medical Plan. SCICN-VC earned $86,230 in shared savings in the first performance year of their Blue Shield ACO PPO contract.

Quality Highlight:

SCICN has focused on aligning with its local Dignity Health hospitals in supporting patients in transitional care management. The SCICN Care Coordination team performs outreach to patients, ensuring they have follow-up visits scheduled and addressing any barriers a patient may be facing. In 2019, SCICN’s Care Coordination team performed more than 4,000 transitional care outreach calls. The Coordination team also works closely with the network’s participating physicians, meeting in their offices to help educate and identify appropriate patients for the voluntary Care Coordination program.

Arkansas Health Network

The largest accountable care organization (ACO) in the state, Arkansas Health Network (AHN) manages over 130,000 lives, including nearly 40,000 Medicare patients. AHN, which is led by a 16-member board, serves patients across central Arkansas.

In 2019 and 2020 AHN continued its multi-year streak of success as a Track 2 MSSP-ACO, each year achieving a new record high for overall ACO savings and earned shared savings. It achieved an overall quality score of 92.17% and 98.19% in 2019 and 2020, respectively.

Since their inception, AHN’s seven-year MSSP total savings has surpassed $50 million, earning $26.7 million in shared savings. In 2022, AHN progressed into the MSSP “Pathways to Success” Enhanced Track.

Strategy Highlight:

A key strategy for the network is to focus on providing population health management services for local employers and their health plans, which includes a high-value provider network and advanced care management. In 2019 and 2020, AHN saved $1.3 million for the CHI St. Vincent Employee Health Plan.

To aid in this employer group strategy, AHN launched a partnership in 2018 with Arkansas Children’s Care Network (ACCN). This partnership involving functional integration of an adult and pediatric clinically integrated network is the first of its kind in the industry. The leading CIN in northwest Arkansas, NextHealth (NH), was added to broaden the scope and geographical reach of services to jointly and better care for Arkansans. Each CIN is independent and collaborates using a multidisciplinary care management approach and advanced analytic tools to manage the members on a self-insured employer’s health plan. Together, AHN, ACCN, and NH can care for members from birth to retirement across the state.

The model, branded AR NetPartners, addresses the rising costs of health care, plan beneficiaries’ health and well-being, and access to primary care in the central Arkansas region. The goal of this innovative, new population health coordinated care delivery model is better patient outcomes and experiences at a lower cost to self-funded employers, and subscribers and beneficiaries of their employee health plans. For more information please click on: www.ArkansasHealthNetwork.com/Employers.