“Healthcare is better when we work together,” says Brian Elisco, Arizona Group CEO for Abrazo Health.
Abrazo, Elisco notes, collaborates with community physicians, each of whom must also be in the business of running a medical practice; shares medical and technological information through forums open to providers from Abrazo’s as well as other health systems; and has business and community leaders serving on its hospitals’ boards of governors, providing valuable input on local healthcare needs. He points also to Arizona’s colleges and universities as important collaborators with Abrazo’s healthcare system. “Through all of these collaborations, our health network benefits by shared knowledge, understanding community needs, gaining support for workforce development, and gaining efficiencies for delivering care in the right place, at the right time,” he says.
Noting that the healthcare industry is experiencing a lot of collaboration and partnerships, Jim Hammond, a healthcare consultant and publisher of healthcare resource The Hertel Report, explains, “I think what’s going on is, instead of buying each other, they realize that they both have very strong brands or they both have very strong markets, and that they don’t need to sell to one another — they can just keep their identities. Because in a lot of cases, they both have great brands.”
Examples Hammond points to are Phoenix Children’s, which is taking its strong brand and doing partnerships with Dignity and with Abrazo rather than getting bought by them. Banner and MD Anderson decided to collaborate and partner rather than one buying the other. “And Mayo and ASU are always doing something,” Hammond says.
Reiterating his point that the strength of the brands in our market is very strong, Hammond says, “So why mess with it? Why have to come up with a new name, or pick one of the two names?”
Of course, if they can build on the strength of both names, all the better, which is what happened with Banner|Aetna. The purpose, however, is the same. Says Tom Grote, Banner|Aetna CEO, “I’ve seen first-hand what’s possible when healthcare partnerships and collaboration truly align, and the impact it has on members and the broader industry as well. My company, Banner|Aetna, was created with a vison to transform this traditionally adversarial relationship into a collaborative, transparent effort centered around improving the member experience.” The organization is half owned by Banner Health, the largest care delivery system in the state, and Aetna, one of the nation’s largest health insurers, which is backed by CVS Health. Under this joint venture approach, Grote explains, both parent companies share accountability for claims costs and profit or losses, which means everyone has an equal stake in getting patients the right level of care at the right time.
“Though health insurance companies and health systems both have an interest in improving the healthcare journey for consumers, they are usually on opposite sides of the payment equation which means there are major barriers to collaboration,” Grote says, noting consumers find themselves stuck in the middle, often left frustrated by challenges related to poor care navigation and a lack of cost transparency.
Sharing, “We view partnerships as deeper collaborations,” Lisa Stevens Anderson, regional market president for Equality Health, cites as one example Equality Health’s partnership with primary care practices (PCPs) like Happy Kids/Feliz Care are truly business partnerships. “We meet on a regular basis to understand their goals as a practice, we create shared goals, and continue to evolve the provided resources to achieve strategic aspects of the partnership,” she says. “Improving the overall health of their patient populations is the ultimate shared goal.”
Partnering a New View of Value
Heather Kane, CEO for UnitedHeathcare Arizona and New Mexico, says some of UHC’s strongest collaborations are borne in the form of value-based care relationships between its coverage plans and local care providers (hospitals and medical practices), which include accountable care organizations (ACOs). “Value-based care improves quality, health outcomes and patient experience. It also helps lower the total cost of healthcare,” she says. “At UnitedHealthcare, we believe we need to keep the remarkable strengths of the U.S. healthcare system as we use value-based payment models and population healthcare models to transform it. This effort requires ongoing collaboration and continual feedback from all involved.”
Explaining that value-based care arrangements with providers pay for outcomes of care for patients, not per transaction a/k/a fee-for-service, Kane notes it places emphasis into measuring, standardizing and improving patient outcomes, as well as on access, timeliness, safety and coordination. “Patients’ experiences are placed at the center of our endeavors and care providers are focused on outcomes, value and appropriateness of care.” Population health management, another vital aspect of value-based care, is a process that includes many approaches, like improving access to care and addressing social determinants of health. Teams work to avoid expensive costs like hospital readmissions and avoidable emergency room visits. “We also have a special asset: our UnitedHealthcare clinical transformation field teams. They help identify additional opportunities, share best practices and support providers with data and technology.”
For instance, “Through our collaboration with Banner, sharing data and setting quality standards is a key tenet of this plan, which creates better outcomes and lower costs for all,” Kane says. “The cost-benefit to the patient is the result of more efficient, higher-quality and thus lower-cost care delivered by the provider, Banner, through its ACO.”
From an accountable care perspective, Kim Shepard, market president of Cigna Healthcare of Arizona, notes Cigna has a number of collaborative accountable care (CAC) arrangements in Arizona, pointing out that accountable care arrangements, including CAC arrangements, have existed for some time. “In fact, Cigna Healthcare just celebrated its 15th anniversary of its CAC program,” she says. She sees these value-based arrangements becoming more prevalent as health plans move to paying providers based on improved health outcomes instead of the traditional fee-for-service model, which pays providers based on volume. “These programs are aimed at providing better overall health, affordability and experiences for communities.”
Overall, Shepard says, “When it comes to healthcare and how we partner with both our employer clients and providers, one phrase comes to mind: better together.” Cigna is committed to collaborating with various partners to ensure it is serving both the physical and mental health needs of the customers being jointly served. “Whether it’s through things like accountable care arrangements, in which we partner with providers on improved health outcomes for our customers, or more tailored innovations to best suit the needs of an employer’s workforce, Cigna Healthcare is always looking for ways to make the healthcare system work better for everyone.”
A Wider Reach for Access
“You might say that Equality Health’s business model is rooted in partnerships — teaming up with other organizations is at the core of the model we have built and in our DNA,” says Lisa Stevens Anderson, regional market president of Equality Health. This focus comes from recognizing that, while healthcare is complicated for everyone involved, those complications are acutely apparent among people who have complex chronic conditions in underserved communities, which present additionally challenging circumstances.
“Healthcare disparities are prevalent across the U.S. and Equality Health was created to improve access to quality care for people who have long struggled and need it the most,” Anderson explains. As a value-based care leader, Equality Health is working to shift the overall healthcare industry from the currently entrenched fee-for-service model to value-based care, an important movement to enhance patient outcomes and population health and reduce healthcare costs.
“We focus on independent PCPs who are challenged by the administrative burden associated with value-based care. We support these practices with the tools, training — including culturally competent care training — and technology that streamlines their clinical workflows, allowing their providers to focus on practicing medicine,” Anderson says. “We view PCPs as the engine of change because they are the first and often the continuous point of care for people in underserved communities.”
Equality Health partners all day, every day with key stakeholders across local markets throughout Arizona. Its partnerships include managed care organizations, local PCPs and community-based organizations, along with the member patients themselves, to ensure people most in need get access to vital healthcare and other resources in order to optimize their health. Additionally, Equality Health Foundation extends those partnerships to improve the health of communities.
Partnerships are also big with managed service organizations, according to Hammond, who provides a purely practical rationale. Explaining that there’s the provider side of the business and the administrative side of the business, he says, “Sometimes the providers are saying it’s too hard to be the administrative side of the business; we’re just going to buy that — or partner with somebody who can do that for us.”
Being one-of-a-kind can make an organization an attractive partner to others, and Phoenix Children’s has several partnerships that Rich Lehmuth, senior vice president and strategic planning and chief strategy officer for Phoenix Children’s, says stand out for their impact on Arizona patient families. “As Arizona’s only pediatric health system, we make it our mission to ensure children statewide have access to world-class healthcare, whether they’re facing a chronic illness, traumatic injury or need primary and preventive care,” he says. Over the past 20 years, Phoenix Children’s has made it a priority to expand its clinical ranks to offer comprehensive, fully integrated care within its health system. “Still,” he says, “we’re keenly aware collaboration is key to building innovative programs, offering cutting-edge treatments and best serving our patients. Our partnerships with healthcare, business and educational organizations in Arizona and nationwide enable us to offer the full spectrum of high-quality, patient-centered care Arizona families need and deserve.”
Among Phoenix Children’s collaborative partnerships are Bone Marrow Transplant Program, which is jointly accredited with Mayo-Phoenix, and the Barrow Neurological Institute at Phoenix Children’s, to care for children with neurological, behavioral and mental health conditions.
For Cigna, Shepard share, “One tailored partnership that comes to mind is Your Call, a collaboration that Cigna Healthcare has with the City of Scottsdale and HonorHealth, that is designed to address the specific health needs of the city’s firefighters.” The goal, she explains, was to go deep into firefighters’ working environments to develop a personalized approach to their care. “Doing so helps us support firefighters as they develop lifelong health-management behaviors on and off the job, as well as in retirement.”
Equality Health also gets involved in local communities through its nonprofit Equality Health Foundation, to deliver support and partner with community-based organizations that include federal, state and local municipalities. For example, Anderson shares, “During the pandemic, we created a public-private alliance that delivered life-saving and preventive COVID-19 resources and services in diverse, underserved communities that simply didn’t have access.” Equality Health Foundation worked with many community partners to deliver testing, vaccines, immunizations, medical care and social support, as well as hand sanitizers and masks during the height of the pandemic to nearly 90,000 Arizonans across multiple counties: Maricopa, Yuma, Pima, Santa Cruz and the San Carlos Apache Tribe. “The work of this public-private alliance still continues, delivering support for pandemic recovery, healing, building resiliency and helping people get boosted with the vaccine.”
Hammond notes that the collaborations with community service organizations allow those community service organizations to get some revenue. “AHCCCS has broadened the scope of services they’ll reimburse to include some services offered by community service organizations, like counseling or transportation or other things that are helpful and worth spending money on but offered by organizations that are, traditionally, not healthcare providers.” Underscoring a crucial point, he adds, “And they’re not traditionally built to bill a payor. So, they need to partner with someone who already does that.” Seeking to add a new skill set, an organization may decide it makes sense to partner with someone else, and then the partner gets paid a fee for managing that part of the business that the community service organization doesn’t have. “For instance,” he says, “it’s silly for a not-for-profit assistance org to have to build a claims department.”
Addressing other goals and benefits, Elisco speaks to Abrazo Health’s strong commitment to workforce development. “Some of our most collaborative and beneficial partnerships involve relationships with nursing and medical schools,” he says, noting there will always be a need for nurses, physicians and other clinical staff. “We have forged relationships with nursing and medical schools to facilitate a strong pipeline of quality providers for our hospitals.” Abrazo also supports career ladder programs for its own employees to advance their skills and leadership.
Abrazo has been partnering with medical schools for years through its graduate medical education programs, Elisco shares. “This helps meet hospital staffing needs and reduce time new grad RNs need to become acclimated to the Abrazo way and their new position. These workforce development programs help meet current and future needs for hospital staffing, as well as bringing new physicians into the community as they graduate from our residency programs.” And Elisco adds, “It’s fundamentally important for the State of Arizona as we continue to develop our workforce to meet present and future needs.”
Through the partnership that created Banner|Aetna, the new organization has both operational and clinical expertise from these different organizations. “And we allocate services based on proficiency,” Grote says. “So, in our case, the insurance side (Aetna) manages the operational aspects of the health plan, like paying claims, billing and customer service. This keeps care decisions with Banner Health providers, who focus their efforts on improving care quality and access and managing utilization.” He believes this will continue to drive truly innovative, integrated solutions that address common consumer pain points like billing confusion and care management.
“When it comes to taking care of members who have complex or chronic health conditions like heart disease or diabetes, our unique payvider relationship also creates a foundation for keeping care decisions in the hands of the clinicians and patients, where they belong. Our care management program is staffed by Banner Health doctors, social workers, case managers and dieticians so the people who already care for our members are guiding them down the path to better health.”
Grote describes Banner|Aetna as having a unique structure that, he believes, provides such advantages as richer data and more interoperability across member touchpoints. “And most importantly,” he says, “we have greater accountability for more sustainable cost savings.”
Partnership was key to Blue Cross Blue Shield of Arizona launching its Clinical Rapid Response Team last year. Says Pam Kehaly, president and CEO, “We knew we could not do this work alone — we needed to link up with other Arizona healthcare industry leaders to make it all possible. To speed up appointment timelines, for example, we started reaching out to providers with different specialties in our network, hoping they would want to help.”
This team was formed to make it easier for Blue Cross Blue Shield of Arizona members faced with a life-altering diagnosis by helping them navigate the healthcare system and clear barriers where possible, assisting with things like accelerating necessary approvals for procedures, treatments and medications; expediting appointments with in-network providers; identifying solutions to support care from unique specialty providers who are out of network; and making connections with BCBSAZ’s experienced care managers and other supportive community resources.
“The Rapid Response team helps our Blue Cross Blue Shield of Arizona members get the answers they need, particularly those who experience a serious diagnosis like cancer or Multiple Sclerosis,” Kehaly says. “We have a direct email that takes members to the right person, at the right time — connecting them to support when they need it most.”
Electronic integration is a big part of partnership, enabling files to better connected and data to be shared, and Hammond points to ACOs’ interest in working with IT companies in order to mine for data, figure out who their at-risk members are and the best ways to reach those people.
Integration also connects with another very hot topic, Hammond notes: behavioral health. “How do you talk about mental health in your primary care practice?” he asks. “Or how do you give people primary care if they’re in your mental health practice?” According to Hammond, there’s a lot of federal money and state money being pushed toward behavioral health integration. “The old stigma of ‘go to the doctor for healthcare and a shrink for your mind’ is outdated. You are a holistic being and it’s all connected, so why do we split that out.” Observing that there’s a lot of stigma-challenging going on right now about where patients should go for their mental health, he says one solution is behavioral health organizations partnering with primary care organizations. In fact, he says, “There’s a lot of federal encouragement to integrate behavioral health with physical health networks, including funding through the Targeted Investment Program.”
He calls out evolvedMD as a great example of this. “EvolvedMD is a behavior health organization that plugs into the primary care. No new offices needed; they put professionals on-site in these places to do behavioral health at the primary care office. And it gets billed by the primary care office, so it looks and smells like it’s being done by the primary care organization. but there’s really a behavioral health organization in there, too.” EvolvedMD did a lot of its growing during COVID, and realized there was no need to rent more spaces but rather put a counselor into a space already in the primary care office. “Patients can get their care in same place and it’s all integrated into the same record.”
In the healthcare industry overall, Hammond says, “I think people are exploring opportunities to work together rather than do a purchase and take people over.” Noting that going through a purchase and actually buying another organization is hard and expensive, he offers, “With collaboration, you don’t have to go through all that; just cooperate with each other.” Each can take advantage of the other’s expertise, and having another perspective is appreciated as they go into it with the attitude, “Let’s learn from each other without having to buy each other.”
Strengthening Healthcare Delivery and Fostering Future Innovation
Workforce development gets a big push in Abrazo’s partnerships with nursing and medical schools – which, ultimately, improves delivery of healthcare services. “Abrazo has been partnering with medical schools for years through our graduate medical education programs,” says CEO Elisco, noting that Abrazo includes residents as an integral part of the healthcare team. Abrazo’s residency programs include Family Medicine, Emergency Medicine, Internal Medicine, General Surgery, Transitional Year and a Cardiology Fellowship. “There are 109 residents and two cardiology fellows in training at Abrazo hospitals. The Abrazo Family Medicine Residency has a close relationship with Midwestern University, which runs a clinic on the Abrazo Central Campus.”
Abrazo’s partnerships with nursing schools include Arizona State University, Grand Canyon University, Chamberlain University and, Elisco says, “of course the Maricopa County community colleges.” Explaining, “These collaborations provide increased visibility for Abrazo on-campus to introduce students to our hospitals and the support,” Elisco says Abrazo provides for new grad RNs through externships and novice nurse programs. “For example, teams of student nurses can be placed in areas of critical need like Surgery, ICU, Emergency and other departments. Students are immersed in learning Abrazo standards, protocols and policies and culture. Upon successfully passing the NCLEX exam the student, now a new grad RN, can be transitioned to an RN position with minimal orientation hours since they have spent the last 12 to 18 months as student and extern in the same area.”
All of which supports Elisco’s previously included statement, “These workforce development programs help meet current and future needs for hospital staffing, as well as bringing new physicians into the community as they graduate from our residency programs. It’s fundamentally important for the state of Arizona as we continue to develop our workforce to meet present and future needs.”
Banner Health and Aetna established an initial partnership while working together as part of an early accountable care organization. As an ACO, both organizations shared responsibility for the quality, cost and coordination of care, and found success in terms of membership growth and cost savings. But the model still limited how much they could collaborate to fundamentally transform the healthcare experience for members. In 2017, Banner|Aetna officially launched. “The company was built on this foundation of trust, with 50/50 financial alignment between health system and payer as one of the earliest joint venture health plans, or ‘payvider’ models, in the country,” says CEO Grote.
With the aim to make the healthcare system work better for everyone, Grote says, “As a nimble, Arizona-based company with pooled support from powerhouse parent organizations, Banner|Aetna is in a unique position to bring member-focused, cutting-edge solutions to market rapidly. We set the standard for healthcare innovation in Arizona and have proven our ability to scale initiatives to other markets to improve the health of even more people.”
Banner|Aetna has both operational and clinical expertise from these different organizations and allocates services based on proficiency. And Grote observes that its unique structure comes along with advantages like richer data and more interoperability across member touchpoints.
“For example,” Grote shares, “at the onset of the pandemic, Banner|Aetna was the first insurer in the country to make text-based primary care available to members as demand for alternative health care delivery methods surged. And, of course, our novel frictionless billing solution puts members first to solve complicated, industry-wide issues with the cumbersome medical billing process. Due to positive reception among members, Banner Health is now looking to expand the program.”
And Grote notes that, when it comes to taking care of members who have complex or chronic health conditions like heart disease or diabetes, “ours unique payvider relationship also creates a foundation for keeping care decisions in the hands of the clinicians and patients, where they belong.” The care management program is staffed by Banner Health doctors, social workers, case managers and dieticians, so the people who already care for the members are the ones involved in guiding them down the path to better health.
“We have also been able to rapidly implement life-changing technologies like a virtual diabetes program to help members manage their condition without the use of expensive medication,” Grote says, noting that in less than a year, the team was able to provide access to the program — producing results of a 48% reduction in diabetes-related medication use and even diabetes reversal for Banner|Aetna participants. “And even better, a two-year retention rate of 70% shows members stick with the program and achieve a sustainable health transformation.”
Blue Cross Blue Shield of Arizona
As Blue Cross Blue Shield of Arizona launched its Clinical Rapid Response Team, the organization recognized the need to link up with other Arizona healthcare industry leaders and started by reaching out to specialists in its existing network asking if they were willing to get on board.
“Dr. Barry Hendin, a Valley neurologist, was among the first to say a resounding ‘absolutely,’” President and CEO Kehaly relates. “After meeting with our Rapid Response Team and learning about our efforts, Dr. Hendin is eager to help our members with Multiple Sclerosis who reach out to the Clinical Rapid Response Team. That means we can rely on him as our go-to in-network provider for members with Multiple Sclerosis. If we get a Multiple Sclerosis-related email in our Rapid Response inbox, we will call Dr. Hendin to see if he can, for example, prioritize the member’s appointments to cut down on wait times and worry. As there are different types of Multiple Sclerosis with varying degrees of severity, getting in the door for treatment early is crucial.”
With that shared passion to improve the health of those living with Multiple Sclerosis, BCBSAZ formalized this collaboration as the ‘MS Community of Practice.’ And Kehaly says, “We are thrilled that five other key providers in the state are now on board.”
The group held its first official meeting in February. Says Kehaly, “The MS Community of Practice is just getting started, and we are excited to see our vision and shared goals come to life. Nearly one million people in the U.S. have Multiple Sclerosis, according to the National Multiple Sclerosis Society. Our goal with this collaboration is to remove barriers and increase access to care and treatment for affected Arizonans. Getting a serious diagnosis is tough enough and navigating the often-complex healthcare system should not be an added layer of concern.” She believes the MS Community of Practice will allow BCBSAZ to look at the healthcare system from all angles, and help it identify what it can improve so that people with Multiple Sclerosis can live their most fulfilling lives.
“Our MS Community of Practice empowers us to think bigger and do better,” Kehaly says, explaining BCBSAZ will use feedback from the providers in the MS Community of Practice about medical policies related to Multiple Sclerosis therapy to understand where there are opportunities for improvement or better alignment. “Because they work directly with those living with Multiple Sclerosis and are up-to-speed on the latest advances in their field, we place a great deal of trust in and value their insights,” she says, adding, “As we reexamine our own policies, we are also looking to encourage a national dialogue about Multiple Sclerosis therapy and different approaches to MS care through the Blue Cross Blue Shield Association. We want to engage providers in insurance policy conversations because their input is vital and could ultimately change the way people with Multiple Sclerosis receive care.” In fact, she says, “We hope this collaboration inspires other healthcare organizations and industry leaders across the country to think outside the box. While our MS Community of Practice is new, it can serve as a blueprint for how health plans and providers can partner to streamline care delivery, optimize health, and develop new approaches to care.”
While providers and health insurance organizations have different roles in the healthcare system, Kehaly notes they have the same goal of impacting health. “We realize that when we work in silos, we may overlook the greatest opportunities to innovate solutions and improve healthcare for those who need it most. Bringing the greatest minds to the same table with diverse ideas and expertise can make all the difference in improving the lives of Arizonans.”
In collaboration with the City of Scottsdale and HonorHealth, Cigna formed Your Call in March of 2021 to address the specific needs of the city’s firefighters. Explains Arizona Market President Shepard, “There are so many firefighters who have experienced job-related illness due to cancer-causing agents and other toxic exposures. Cancer risk, in particular, has compelled fire departments to look for different strategies to combat and manage health disparities.” In fact, she notes the National Institute of Occupational Safety and Health has indicated that firefighters are more than twice as likely to be diagnosed with an invasive cancer as the average person. Firefighters have increased exposure to cancer-causing agents, which increases the prevalence of colon cancer, kidney cancer, bladder cancer, brain cancer and lymphoma. “As a result of this, Cigna Healthcare sought to perform more aggressive screening of firefighters from our government clients and their medical consultants.”
In addition to increased cancer risk, Cigna also recognized that firefighters can suffer from chronic injuries, often have health challenges in retirement, and many lack a primary care physician. Says Shepard, “We saw this as an opportunity to work on a solution to prevent premature deaths and improve the overall health and vitality among firefighters.”
Your Call is available to every Scottsdale firefighter at no cost. HonorHealth is the program’s dedicated provider, offering concierge phone service, a dedicated care coordinator and four doctors trained in firefighter health protocols. These doctors check in with firefighters on their physical and emotional well-being, evaluate current health issues based on the challenges firefighters often face, and order targeted firefighter screenings. This includes screenings for depression and anxiety, genetics, physical fitness, heart and lung disease and cancer.
Overall, this program is aimed at early detection and prevention of diseases and illness among firefighters, which helps manage costs by identifying and treating expensive conditions early on, Shepard explains. “This, in turn, creates efficiencies across the board for Cigna Healthcare, HonorHealth and the City of Scottsdale, especially due to features like care coordination in which we can work with providers on coordination of health services (be it referrals, medications or social determinates of health needs) for our customers.”
Your Call is one example of Cigna’s long record of partnering with clients and providers to bring unique healthcare innovations to its customers within local markets. And Shepard sees Arizona as a model in terms of how Cigna might address other high-risk workforces across the country. “We know that cancer screening does not prevent cancer, but good primary care promotes early detection and results in higher survival rates. Working with our firefighter customers and provider partners, we have identified key intervention points within the firefighter health care journey — and programs like these really set us apart in the market both nationally and locally. While we have developed Your Call in Arizona, we have created initiatives in other markets that are focused on critical areas like maternal health and breast cancer screenings.”
“You might say that Equality Health’s business model is rooted in partnerships — teaming up with other organizations is at the core of the model we have built and in our DNA,” says Regional Market President Anderson. “We believe strongly that partnerships in healthcare are crucial to creating a working health ecosystem. Our approach has allowed Equality Health to have the opportunity to impact the lives of 750,000 people through our collaborative partnerships with 25 health plans and more than 3,200 PCPs across our broad network throughout Arizona, Texas and Tennessee.”
As she explained earlier, Equality Health focuses on partnering with primary care practices, which, she points out, are a crucial point of care for patients, especially in underserved communities. “Happy Kids/Feliz Care is a wonderful example of our partnership with localized PCPs,” she shares. “This is a pediatric and primary care practice based in Phoenix with 11 clinic locations across the metro. This practice was founded by Dr. Jose Francisco Carrazco decades ago and they took a chance on a new value-based care partner right when Equality Health was starting out. They were one of our first PCPs to join the Equality Health value-based care network back in 2017 and they have been with us ever since!”
Equality Health works with Happy Kids/Feliz Care across all their value-based contracts and supports the practice with a range of technology and services, including access to value-based risk contracts; providing a dedicated performance practice manager who helps the practice gain access to social determinants of health services like housing, food and transportation for their patients in need of such services; and offering the CareEmpower technology platform, which helps the practice track patient populations and report for the new value-based care quality metrics.
“We allow Dr. Carrazco and his team to focus on delivering whole-person, culturally competent care to patients and we unburden the team of the heavy administrative work of value-based care administration,” Anderson says.
Anderson notes that, nationally, there is a major push to complete the healthcare industry’s transition from fee-for-service to value-based care, which has been going on for more than a decade. In fact, she points out, according to the Centers for Medicare and Medicaid Services, all Medicare payments and the vast majority of Medicaid payments will be governed by value-based contracts by 2030.
Says Anderson, “Arizona is at the forefront of value-based care, and we are tremendously proud to be a part of driving the change with committed partners throughout our community.”
“Our mission is to advance hope, healing and the best healthcare for children,” says Phoenix Children’s SVP Rich Lehmuth, noting it is the touchpoint for every decision at Phoenix Children’s, from hiring and expansion to its investment and partnership strategies.
In addition to the collaborative partnerships mentioned earlier in this article, Lehmuth shares several of Phoenix Children’s other partnerships that he believes stand out for their impact on Arizona patient families.
One of its collaborations with ASU is the Edson College of Nursing and Health Innovation. In 2018, Phoenix Children’s and ASU formed a joint operating commission (JOC) to enhance educational opportunities and research efforts, train the next generation of pediatric clinical talent and address a looming nursing shortage — especially in specialty care. First up for the JOC was the 2019 launch of two new programs: The Dedicated Education Unit, as well as The Acute Care Pediatric Nurse Practitioner Doctor of Nursing Practice and Certificate Program Curriculum.
DEU for undergraduates provides nursing students with 45 hours of elective time at the pediatric patient bedside. They’re paired with a nurse preceptor for six full nursing shifts, giving them valuable clinical experience earlier in their education.
The Acute Care Pediatric Nurse Practitioner DNP and Certificate Program Curriculum trains graduate-level nursing students to care for children with acute medical needs. In addition to DNP-level coursework and clinical hours, students in this program complete a major intervention project in their third year of study. They identify an issue in patient care, conduct ongoing research and implement a solution within a department. Their insights and research are then integrated into Phoenix Children’s care model.
Says Lehmuth, “Not only does the program provide additional opportunities for ASU students, but it fills the pipeline with workforce-ready nurses specializing in pediatric care.”
And Phoenix Children’s has numerous research and education partnerships with medical schools, which include the University of Arizona College of Medicine, Mayo Medical School and Creighton University School of Medicine to teach the next generation of pediatric doctors and specialists.
Observing that few things are more important than high-quality medical care for newborn babies, especially when their health is at risk, Lehmuth points to Phoenix Children’s ongoing partnership with Dignity Health. “We began providing the neonatologists for the NICU at St. Joseph’s Hospital and Medical Center in July 2021. Under the leadership of Gregory Martin, M.D., Phoenix Children’s division of neonatology is consistently ranked among the nation’s best by U.S. News & World Report’s ‘Best Children’s Hospitals.’ This means Dignity Health families have access to top-ranked, best-in-class newborn care along with pediatric subspecialists in more than 75 specialty areas
Another major highlight occurred just recently. “We put a major stake in the ground when Phoenix Children’s and the University of Arizona College of Medicine – Phoenix, appointed Vladimir Kalinichenko, M.D., Ph.D., as director for the Phoenix Children’s Research Institute at the University of Arizona College of Medicine – Phoenix and professor of Child Health with tenure in March 2023,” says Lehmuth. Dr. Kalinichenko is internationally renowned for his research in lung development and regeneration. His role at Phoenix Children’s will include recruiting established scientists to Arizona, nurturing the next generation of researchers, securing grant funding and advancing scientific inquiry across the health system in Arizona.
And then there’s the Phoenix Children’s Care Network.“In 2013, we created Phoenix Children’s Care Network, the nation’s first Utilization Review Accreditation Committee-accredited pediatric clinically integrated network,” says Lehmuth, noting PCCN includes more than 1,200 pediatric providers who deliver care across more than 75 subspecialties across Arizona. The network includes 80% percent of specialists and 50% percent of primary care providers in the state.
Lehmuth notes PCCN’s care delivery model is designed around value-based contracting as opposed to the standard fee-for-service. “Early on, we tasked our practitioners with developing the benchmarks against which they’re measured. Physician and network partners committed to 14 primary care measures and 34 specialist metrics encompassing safety, quality and transparency outcomes. Reimbursement rates are now tied to these measures, holding us all to a high standard of quality outcomes at a lower cost,” he says.
“Guided by our mission, we continually raise the level of care we provide and strengthen our reputation both locally and nationally. This is evidenced by our rankings with national organizations like U.S. News & World Report,” says Lehmuth, noting that Phoenix Children’s has been recognized for 12 consecutive years as Arizona’s only ‘Best Children’s Hospital.’ “In addition, our programs have received many designations that attest to the high-quality care we provide.”
“All of this matters because families in Arizona — and those moving here in record numbers — need and deserve local access to world-class care,” Lehmuth says. “A top-ranked pediatric health system also reinforces Arizona as a great place to live and work and a more attractive state to do business.””
UnitedHealthcare in Arizona launched a collaborative relationship with Banner Health Network under the plan name Arizona Doctors Plan in January 2021. The plan provides personalized and seamless customer support and flexibility in accessing care from 15 Banner Health medical centers across Maricopa and Pinal counties. “This,” says CEO Kane, “is a terrific example of payers, health systems and primary and specialty physicians working collaboratively to keep members in optimal health while reducing costs. Arizona Doctors Plan members have access to care from more than 5,000 physicians in the Banner Health Network, all of whom are dedicated to delivering cost-effective and evidence-based care.”
Kane explains the plan offers members the opportunity to save up to 15% on premiums compared to a traditional PPO offering; offers access to primary care and urgent care visits for a $0 co-pay, as well as 24/7 telehealth visits and care coordination driven by their primary care physician. “The design of the plan helps to create a seamless experience for both fully insured and self-insured members,” she says.
“Rewarding excellence in healthcare delivery based on patient outcomes has been proven to reduce healthcare costs, improve quality and enhance the patient experience,” Kane says, noting this is a change as the United States healthcare system has been dependent on a volume-over-value approach, rooted in a fee-for-service payment system that compensates physicians, hospitals, manufacturers and other healthcare providers for each service, test, drug and device delivered. “Because of our ongoing commitment to this access, quality of care and affordability effort, 14.4 million UnitedHealthcare members currently access care from physicians in value-based arrangements.”
As Kane notes, “Part of our work to advance a value-based system of care is rooted in the meaningful opportunity to drive better outcomes and greater affordability for consumers and the health system by helping people access high-quality care in a low-cost setting.” In fact, she points to research by UnitedHealthcare Group that shows shifting routine outpatient procedures from a hospital outpatient department to a lower-cost ambulatory surgery center could save $75 billion over the next decade.