November 17, 2015: NRHI SAN Learning Event Kick-Off Event View the presentation

The Network for Regional Healthcare Improvement (NRHI) is a national network of 35 Regional Health Improvement Collaboratives or RHICs. A RHIC is a local or state-based trusted convener of stakeholders working to transform how health care is delivered and paid for in a community. A RHIC is a non-profit, non-governmental organization, and by virtue of its trusted role within the community —it is not a purchaser, not a payer, not a provider of health care services —has established long-term and trusted relationships with the local provider network, medical schools, medical societies, employers, health plans, state agencies, legislators, consumers, and others involved in health care. As the national network of 35 RHICs, NRHI’s mission is to elevate and spread evidence-based strategies, tools, and clinical and quality experts from regional collaboratives across the U.S. In other words, RHICs have already figured out many tried and true strategies to transform health care—why reinvent the wheel?

RHICs lead local or state initiatives in quality improvement and practice transformation; performance measurement/reporting; delivery system and alternative payment methodologies; patient engagement; total cost of care (TCoC); and other topics. RHICs have a unique role within the community because they invest in long-term trusted partnerships with all stakeholders: providers, purchasers/employers, consumers, and payers. And because RHICs actually do the hard work of healthcare transformation within their regions or states, they bring pragmatic and effective strategies to the Transforming Clinical Practice Initiative.

For more information:

What is a RHIC?

Who are NRHI RHICs?

If our healthcare system is going to transform, multi-faceted approaches will be needed to overcome all of the barriers in a coordinated way. These approaches will, by necessity, be different in different parts of the country since there are significant variations in the structure of healthcare and in the specific types of quality and cost problems in each community. These factors make it highly unlikely that any one-size-fits-all national solution will work.

Moreover, since the healthcare stakeholders in a community—consumers, physicians, hospitals, health plans, businesses, government, etc.—will be affected in important ways, each stakeholder needs to be involved in planning and implementing changes. In many communities, there is considerable distrust between different stakeholder groups pointing to the need for a neutral facilitator to help design “win-win” solutions.

Many communities across the country recognize that RHICs are an ideal mechanism for developing coordinated, multi-stakeholder solutions to transform how healthcare is delivered and paid for. A RHIC does not deliver health care services directly or pay for such services; rather, it provides a neutral, trusted mechanism through which the community can plan, facilitate, and coordinate the many different activities required for successful transformation of its healthcare system.

For the Transforming Clinical Practice Initiative, NRHI will offer the High-Value Care Learning Program to interested PTNs and their provider networks. This program includes five areas of transformation to impact high-value care: (1) understanding total cost of care; (2) adopting effective care transitions; (3) creating patient-centered care homes; (4) addressing inappropriate utilization through the Choosing Wisely initiative; and (5) effectively engaging patients and families. Each of these components and the related clinical and quality faculty are described below.

The High-Value Care Learning Program will start with an understanding of total cost of care (TCoC): how it is defined, why is it critical to practice transformation, what TCoC results look like in regions across the country, how the TCoC and resource use measures can inform clinicians about why their costs are high or low, and, most importantly, what they can do to effect them.

Over the past decade, there have been extensive efforts to measure and improve the quality of healthcare services in the United States. In communities all across the country, physicians, hospitals, health plans, government agencies and community organizations are measuring the quality of care and implementing initiatives to improve quality. While much still remains to be done to improve the quality of healthcare services, concern about the cost of healthcare services has become an equal or greater concern for the nation, since high quality care is of little good if patients cannot afford to obtain it. Furthermore, improvements in the quality process have not yet yielded expected measurable savings. In fact, the costs of healthcare have continued to rise. In response, the conversation has shifted to improving value, which encompasses both cost and quality. Purchasers and consumers are increasingly demanding accountability for cost and seeking to differentiate among providers and practices that manage resources effectively. Finally, as physicians increasingly enter risk contracts, they need transparent cost and utilization data to be successful in managing population health and costs. The first step to ensuring that resources are well used is to know where they are being used. Ultimately, payment reform will be advanced by understanding, measuring and reporting TCoC.

NRHI has led the Total Cost of Care Multi-Region Innovation Pilot for the Robert Wood Johnson Foundation since 2013. The initiative supports physicians, practices and RHICs in five geographic areas (two more sites are being added this year) developing and producing information to ultimately enable communities to understand and reduce the total cost of care in multiple regions with replicable, multi-stakeholder driven strategies. The RHICs are analyzing claims data and calculating total cost; identifying differences in total cost for apple-to-apples comparisons; and learning how to share this information in a professional, appropriate, and meaningful way with physicians so that they have knowledge of costs associated with their care delivery and referral patterns and tools for impacting cost drivers. Through analysis of cost information, communities are identifying the key drivers of TCoC /high-value care, which, in turn, allow providers to adopt evidence-based interventions and best practices in response to the cost drivers. Best practices, strategies, expertise, tools and materials from the RWJF project, including a curriculum and training to teach other regions to produce TCoC results using their regional data, will be leveraged for TCPi.

While they will not calculate TCoC for their individual practice, clinicians participating in NRHI’s SAN will understand what TCoC is, why we need to talk about it, what practices in five regions are learning about it, where the field is headed, clinician concerns around TCoC, perceived patient concerns, etc. Two leaders in this field, Minnesota Community Measurement (MNCM) and the Institute for Clinical Systems Improvement (ICSI), will serve as clinical and QI expert faculty for this part of the program. MNCM released the country’s first report on TCoC at the practice levelⁱ, and ICSI is a leader in engaging clinicians in an authentic and effective way around the difficult conversations about cost of care and appropriate care.

The Pittsburgh Regional Health Initiative will provide expertise on care transitions and care management, specifically hospital discharges attributed back to PCPs. PRHI will leverage expertise and tools developed in the Primary Care Resource Center Project.¹ The PCRCP is a $10.4 million, 3-year PRHI demonstration project, funded by the CMMI which creates and tests a novel model of support for PCPs affiliated with community hospitals. The main clinical targets of the project are to reduce 30-day all-cause readmission rates for chronic obstructive pulmonary disease (COPD), heart failure, and acute myocardial infarction by 40% from historical baselines. Funding is used to create a care coordination team at each of 6 community hospitals in western Pennsylvania and West Virginia, composed of experienced nurses and pharmacists specifically trained in care transitions, readmission reduction, and advanced primary care, using existing PRHI curricula. The project also adapts methods validated in studies such as Project BOOST² and the Transitional Care Model³, but customizes the care around the three high-volume conditions and for the host facility’s resources and primary care practice community. Early projections estimate potential Medicare cost savings of up to $43 million over the term of the grant. The project has been recognized for reducing preventable COPD readmissions⁴ and defining a critical role for the ambulatory pharmacist⁵.

Another area of the High-Value Care Learning Program is engaging patients and families in their care—a body of work in the field that is rapidly evolving and a consistent theme throughout the TCPI phases of transformation. Massachusetts Health Quality Partners (MHQP) will lead this work and will provide expertise on alignment of measures and engagement with the public and private sector. MHQP has been measuring and reporting on the patient experience since 1998 and has documented improvements in PCP communication, coordination of care, knowledge of their patients and patient access to care across MA. Studies dating back to the late 1980s and early 1990s have found that physician-patient interactions have an impact on clinical outcomes and patient adherence to their doctors’ recommendations.^{i ii iii} MHQP worked with NCQA to pilot test the patient experience survey currently used for the PCMH CAHPs. MHQP also teamed up with Consumer Reports to provide Massachusetts consumers with reliable and useful information about PCPs in the Commonwealth^v, focusing on how best to establish a partnership between patients and their primary care clinicians.

MHQP has worked extensively with consumers and has experience recruiting and supporting an active Consumer Health Council whose members are integrated and engaged in MHQP’s work. MHQP’s governance reflects consumer representation on all of MHQP’s governance and workgroups. MHQP also has lead two broad community coalitions, the MA Child Health Quality Coalition and the Healthier Roxbury Coalition, engaging patients, families and community members to improve care. MHQP brings its expertise, tools, and strategies from these and other efforts in capturing patient experience and patient, family and community engagement to the participants in NRHI’s SAN.

The third area of the Learning Program is impacting inappropriate utilization of services as illustrated through the Choosing Wisely initiative. Maine’s Quality Counts (Maine QC) serves as clinical and QI expert faculty and brings extensive experience leading a multi-stakeholder effort to develop “Choosing Wisely in Maine”. This effort focuses on 5 major strategies: (1) building general public awareness; (2) engaging providers; (3) engaging consumers; (4) testing additional methods for implementing Choosing Wisely recommendations through a set of provider pilots; and (5) identifying areas to engage patients “in the visit” (i.e. within the clinical encounter). Maine QC will leverage its experience working physicians and other providers, consumers, employers, payers and other key stakeholders to help PTNs examine local data to identify focus areas for their local Choosing Wisely efforts. Experienced staff from the Maine QC will share lessons learned in working with the media to increase public awareness through multiple efforts including traditional media, social media, interactive story videos, and personal stories for print media, statewide conferences, educational webinars, and “Twitter Chats” where clinicians and consumers can converse. They will support provider engagement in PTNs by sharing lessons learned in conducting outreach to physician associations and specialty societies, as well as associations that conduct outreach to nurse practitioners and physician assistants, through professional trainings, and inclusion in professional conferences. Maine QC will also work with PTNs to share experience and best practices in working with consumer groups to promote Choosing Wisely messaging.

NRHI’s High-Value Care Learning Program will focus on the patient centered medical home, which Oregon Health Care Quality Corporation (Q Corp) will lead, drawing from experience engaging more than 60 primary care practices in training and technical assistance through its Patient-Centered Primary Care Institute (PCPCI). Founded in 2012, PCPCI accelerates primary care transformation by bringing together health care providers, clinic staff, technical experts, patients, quality improvement professionals and others to learn about medical home concepts and plan for how they will implement them into primary care practice.^vi Q Corp staff have encountered practices with significant expertise in medical home concepts, as well as those just learning about both the importance and mechanics of the medical home. While there are differences in how a practice implements the medical home model depending on their patient population, resources and community context, there is evidence to support starting with engaged leadership, developing a quality improvement strategy and building strong care team relationships.^vii Q Corp has worked with content experts to deliver training and TA in these areas to Institute program participants and can draw on this experience to lead the High-Value Care SAN. Q Corp also held forums with physicians about TCoC and the link to alternative payment methodologies and payment reform that can also be vehicles and templates for taking TCoC work to a broader audience throughout the country.

NRHI will use a multi-faceted structure that will include the following components.

• A virtual kick-off meeting for each High-Value Care cohort. The kick-off meeting will give PTNs and their clinicians an overview of the program, and a foundation into total cost of care/high-value care concepts. The agenda will include an overview of the components that impact high-value care/TCoC so that PTNs and clinicians have a preview of the topics they will tackle in the year ahead. This event will be recorded and available for those unable to hear it live.
• Virtual learning events each month for each SAN. NRHI will convene two monthly videoconferences each on the core topics. The events will range from 90 minutes to 2 hours. NRHI will record virtual events so that those who miss them can listen after the fact, and will post materials on the HealthDoers Platform.
• Collaborative Health Network. The Collaborative Health Network provides trusted peer-to-peer forums and programming to support “HealthDoers” working to improve community health and healthcare. The online and in-person offerings of the Collaborative Health Network are designed to rapidly identify and spread what works, foster meaningful connections, and incorporate participant feedback to set priorities. The Collaborative Health Network’s HealthDoers Platform offers an online, invitation-only, learning community which will be used to connect with other stakeholders involved in delivery system and payment transformation. The HealthDoers Platform allows participants to crowd-source questions, post interesting articles and materials, ask questions of each other, and “meet” in virtual classrooms to hold events in a more personal way. NRHI will make available a private virtual classroom—a videoconference where participants can see and engage with each other and the faculty in real time—available only to participants in NRHI’s SAN.
• Dissemination of tools and materials. NRHI will gather, package, present, and disseminate a set of road-tested tools and materials on the HealthDoers Platform that PTNs and clinicians can adopt, including instructions on how the materials can be used. NRHI’s team will be flexible in terms of dialing up or down the amount of support headed by the PTN. Again, NRHI will leverage its 35-member network for widespread dissemination from SAN and TCPI.
• One-on-one coaching of PTNs. Individual mentoring will be available by individual NRHI faculty to a PTN upon request. For example, a PTN could receive one-on-one coaching from a clinical/QI expert for each core topic area over the course of the year. The coaching will provide individualized support to help PTNs brainstorm, plan, strategize, and use the tools most effectively to advance practices through the TCPI phases of transformation.

	Elizabeth Mitchell, President & CEO, NRHI
	Randy Cebul, MD, President & CEO, Better Health Partnership Northeast Ohio
	Nancy Zionts, Chief Program and Operating Officer, PRHI
	Kate Elliott, Program Director, Q-Corp
	Lisa Letourneau, MD, Executive Director, Maine Quality Counts
	Barbra Rabson, President & CEO, MHQP
	Tina Frontera, Chief Operating Officer, MN Community Measurement
	Cally Vinz, Vice President, ICSI
	David Price, Senior Vice President, ABMS Research and Education Foundation and Executive Director, Multi-Specialty Portfolio Approval Program Organization, American Board of Medical Specialties

NRHI’s informal partners include its national network of 35 regional health improvement collaboratives (RHICs). RHICs are non-profit, multi-stakeholder organizations working in their regions and collaborating across regions to transform the healthcare delivery system and achieve the Triple Aim. RHICs work directly with providers, provider organizations, commercial and government payers, employers, consumers, and other healthcare related organizations.

NRHI’s formal partners in this work include:

• Minnesota’s Institute for Clinical Systems Improvement;
• Minnesota Community Measurement;
• Pittsburgh Regional Health Initiative;
• Massachusetts Health Quality Partners;
• Maine Quality Counts;
• Oregon’s Health Care Quality Corporation;
• Cleveland’s Better Health Partnership Northeast Ohio; and
• The American Board of Medical Specialties.

	Elizabeth Mitchell, President & CEO
Photo Coming Soon!	Stacy Donohue, Senior Program Manager
	Dianne Hasselman, Deputy Director
	Emily Levi, Project Coordinator
Photo Coming Soon!	Ellen Harrison, Chief Operating and Business Development Officer