WHAT ARE REGIONAL HEALTH IMPROVEMENT COLLABORATIVES (RHICs)?
- Healthcare providers (hospitals, physician groups, physicians, home health agencies, nursing homes, clinics, etc.)
- Healthcare purchasers (employers who purchase health insurance for their employees, state Medicaid agencies that contract with health plans for care, etc.)
- Healthcare payers (private health insurance plans, state Medicaid agencies that directly pay for care, etc.)
- Healthcare consumers or consumer organizations
No one can fix the healthcare system alone – it will require change from providers, purchasers, and communities. Through this unique collaboration, the stakeholders are able to tackle compelling health challenges together.
- They work together with everyone who gets care, gives care, and pays for care, to create the system that everyone needs
- They are where competition and collaboration meet
- They know that more can be done together than by tackling these challenges separately
Some focus on improving population health and reducing disparities. Others have developed novel approaches to care management and delivery system redesign, payment reform, and reducing waste and inefficiency. By working closely with local stakeholders, they address the issues that matter most in their communities. Despite their uniqueness, RHICs are bound together by common goals and a shared understanding of what ails U.S. healthcare and how to fix it.
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They convene those who do – and the people and the communities they serve – to identify ways to catalyze change for better outcomes and lower cost.
This enables them to identify key approaches for improvement and measure progress. Since healthcare cost and quality vary by region, it is critical to leverage this access to local data, market knowledge, and multi-stakeholder relationships to address variation and transform care.
RHICs MULTI-STAKEHOLDER STRUCTURE
RHICs Are Different
RHICs Are Diverse
- Some RHICs had their origins in efforts among healthcare providers to work collaboratively to improve the quality of care they were delivering.
- Other RHICs were initially formed through the efforts of health plans or businesses in the community seeking ways to control increasing healthcare costs or to address concerns about healthcare quality in the community.
- In some cases, the RHIC also serves as the community’s health purchasing coalition.
- Still other RHICs were formed from the beginning as multi-stakeholder efforts.
RHICs Align with the States
The regulatory powers and financial resources of state governments give them unique strengths, such as the ability to mandate the submission of quality and cost data by providers and payers and the ability to provide anti-trust safe harbors to help establish multi-payer payment reforms and help independent providers coordinate their services.
RHICs typically obtain their funding from three types of sources:
- Membership Dues. Regional health improvement collaboratives rely on annual financial contributions from the healthcare stakeholders in the community.
- Grants. In addition to membership dues, most RHICs rely on grants from foundations and government agencies to support their programs.
- Consulting and Technical Assistance. Some RHICs provide specific services to healthcare providers, employers, state agencies or others for which they charge a fee.
- RHICs Are Different
- RHICs Are Diverse
- RHICs Align with State Governments
- RHICs Funidng Sources
RHICs Are Different Than Other Healthcare Improvement Organizations
Because RHICs go by many different names, it can sometimes be hard to distinguish them from other organizations at the national, state, and local levels that develop or implement programs designed to improve the quality and control the costs of healthcare.
The key differences between RHICs and other healthcare organizations is that the RHICs are governed by individuals and organizations from the four key healthcare stakeholder groups, and address quality and cost issues across a broad range of patients and providers. This is why RHICs are referred to as “multi-stakeholder” rather than merely “multi-member” organizations.
Other differences are that most RHICs establish their direction through consensus among their members and implement their efforts through voluntary cooperation of the members, rather than through government mandates, financial rewards or penalties, etc.
No two RHICs are structured exactly alike. RHICs are diverse in terms of their structure and programs because of the differences in the number, structure, and capabilities of the purchasers, payers, providers, and other organizations in their local regions.
Some RHICs had their origins in efforts among healthcare providers to work collaboratively to improve the quality of care they were delivering, and then evolved over time to involve a broader array of stakeholders. For example, one of the first RHICs, the Institute for Clinical Systems Improvement (ICSI) in Minnesota, was established in 1993 by three healthcare systems (HealthPartners, the Mayo Clinic, and Park Nicollet Health Services); today, the majority of the members of the Board of Directors are physicians or staff of medical groups, but there are also representatives of health plans, purchasers and consumers on the Board.
Other RHICs were initially formed through the efforts of health plans or businesses in the community seeking ways to control increasing healthcare costs or to address concerns about healthcare quality in the community. For example, both the California Cooperative Healthcare Reporting Initiative and the California Quality Collaborative are RHICs, but they were formed through the leadership of the Pacific Business Group of Health (PBGH), a major business health coalition based in California, and they continue to be housed at PBGH. In some cases, the RHIC also serves as the community’s health purchasing coalition. For example, the Washington Health Alliance is a multi-stakeholder collaborative, but its policy requires that a majority of the members of its board of directors be healthcare purchasers.
Still other RHICs were formed from the beginning as multi-stakeholder efforts. For example, the Pittsburgh Regional Health Initiative (PRHI) was formed in 1997 as a community organization with representation from a wide range of groups that were interested in advancing health care quality – hospitals and physicians, health insurance plans, major employers, consumers, academics, foundations, local government, and civic leaders.
Some regions have two or more RHICs. In these communities, one of the organizations may take responsibility for collecting and reporting on various measures of healthcare quality and/or cost, while another carries out initiatives designed to help healthcare providers improve performance on those measures.
Although state governments play an increasingly central role in healthcare reform, partly as a result of the programs in the 2010 federal Affordable Care Act, RHICs remain critically important to transforming healthcare. The regulatory powers and financial resources of state governments give them unique strengths, such as the ability to mandate the submission of quality and cost data by providers and payers and the ability to provide anti-trust safe harbors to help establish multi-payer payment reforms and help independent providers coordinate their services. There are also important limitations on the ability of state government to carry out key functions successfully, such as:
- The difficulty of supporting multi-year healthcare transformation efforts through election cycles, changes in state administrations and changes in fiscal priorities;
- The difficulty of balancing regulatory enforcement powers with programs to engage stakeholders and facilitate improvement;
- The difficulty of customizing state programs to reflect the diversity of regional healthcare markets within large states.
In contrast, the independence and stakeholder governance of RHICs provides greater ability to support providers through multi-year transformation efforts and to do so in a way that can be adapted to the unique needs of individual geographic regions. Consequently, the greatest success in healthcare transformation will likely come from strong partnerships between state governments and RHICs.
It is critical for RHICs to have adequate resources both to maintain their current programs and to address the increasing demands being placed on them and their local members by healthcare reform efforts. Although program-specific funding is desirable, unrestricted funding is essential to support the core operations of the RHIC and to provide the flexibility to pursue new opportunities in innovative ways -- the true strength of the RHIC. In addition, if RHICs are to remain truly multi-stakeholder, community-based organizations, those resources will need to come from all stakeholders in their communities, as well as from state and federal government sources. This is why obtaining funding to support the work of RHICs is a priority of NRHI's role.
Collaboratives typically obtain their funding from three types of sources:
- Membership Dues. Regional health improvement collaboratives rely on annual financial contributions from the healthcare stakeholders in the community. These types of payments are critical because they provide flexible funding to pursue the priorities of the RHIC (rather than being restricted to particular programs) but even more importantly reflect the commitment and meaningful involvement of local stakeholders.
- Grants. In addition to membership dues, most RHICs rely on grants from foundations and government agencies to support their programs. In some cases, RHICS may receive unrestricted operating grants from foundations which can be used to fund general operations, particularly in the early years of their existence, but more typically, foundation grants will be restricted to use for specific projects and time-limited activities.
- Consulting and Technical Assistance. Some RHICs provide specific services to healthcare providers, employers, state agencies or others for which they charge a fee. For example, some Collaboratives provide technical assistance or coaching to healthcare providers to help them improve their quality of care, or offer reports and analytic support to employers seeking to understand health care trends and costs.