The most recent ranking of the nation's integrated healthcare networks shows top systems are improving outcomes-and cutting costs-by broadening continuums of care and better integrating disease- and case-management programs.
The seventh annual IHN 100, a report from Yardley, Pa.-based research firm Verispan, ranks the top 100 networks among the country's 568 regional, nonspecialty healthcare systems. The analysis rates each system on clinical and financial performance and measures the degree of integration in several categories, including access, contract capabilities, hospital utilization, services and technology.
This year's ranking, released exclusively to Modern Healthcare, includes three newcomers to the top 10: Covenant Healthcare and Aurora Health Care, both based in Milwaukee, and Albuquerque-based Presbyterian Healthcare Services.
Paul Dell Uomo, president and chief executive officer of Covenant, says the four-hospital, 1,500-physician system has improved quality and cut costs by "coordinating care and clinical best practices throughout our system." Covenant had a perfect score in the category that includes clinical integration, which accounts for more than one-quarter of the composite score. It moved up to third in the latest ranking, from 19th last year.
For example, Covenant's congestive heart failure program includes standardized, intensive follow-up from case-management registered nurses, Dell Uomo says. Systemwide, nurses provide phone-call reminders, education and occasional home visits to heart failure patients.
"We have found that our readmission rate has been cut tremendously, and that has saved us several million dollars," Dell Uomo says. (The initiative has slashed the 30-day hospital readmission rate from 12% to less than 4%). Covenant is working toward similar case-management initiatives in its asthma, behavioral-medicine, nephrology and oncology programs, he says.
Presbyterian Healthcare, which moved up to ninth on this year's list from 24th last year, notched perfect scores in both outpatient utilization and contractual capabilities.
Jim Hinton, Presbyterian's president and CEO, says the system is improving outcomes by more closely aligning clinical programs at its eight hospitals with its outpatient clinics. During the past year, Presbyterian has reshuffled its management structure so that its physician practices report to the same administration as its hospital staff.
"When we think about the best way to treat certain diseases, our clinical programs and disease-management strategies should cut across both inpatient and outpatient settings," Hinton says. "There cannot be barriers between the hospitals and our clinics."
He says the system has improved outcomes in its diabetes program by leveraging claims data from Presbyterian's health plan for use in disease-management strategies at its clinics and hospitals. Similar initiatives are being made in the system's asthma and congestive heart failure programs.
Topping this year's IHN 100 for the third consecutive year is Intermountain Health Care in Salt Lake City. The 21-hospital system's focus on information technology and clinical integration has "set the standard" for other networks, says Ed McCauley, director of healthcare and contract research at Verispan. Another fixture on the list's top 10 is Sentara Healthcare, a 70-site system in Norfolk, Va., which ranked seventh this year and has been near the top of the ranking in all seven years.
"The way these model IHNs are structured lends itself to consistency," McCauley says. Indeed, 85 of the systems that made the top 100 also appeared in the ranking last year, reflecting their consistent performance as well as the stability of Verispan's methodology, according to Verispan's findings.
Fifteen systems managed to crack this year's list by improving integration, including SSM Health Care, a St. Louis-based Catholic network of 20 hospitals in Illinois, Missouri, Oklahoma and Wisconsin.
William Thompson, SSM's senior vice president of strategic development, says the network installed a new enterprise resource planning system two years ago. It has streamlined SSM's supply chain, maximized purchasing discounts and eliminated 90% of the paperwork associated with materials management, Thompson says.
Networks ranked in the IHN 100 boast better profit margins, higher volumes and shorter lengths of stay than the 468 systems that don't appear on the list, the report says. For example, profit margins averaged 3.4% for systems on the list, compared with a 2% average for other systems. Average length of stay at the hospitals affiliated with the ranked systems was 5.13 days versus 6.06 for systems not on the list.
Verispan's analysis also found that integrated healthcare networks continue to broaden the scope of their systems by partnering with a growing number of hospitals, medical practices, nursing homes and other providers, rather than acquiring organizations.
"Networks are shoring up weak spots in their continuum of care by adding services and expanding their geographic range," says Verispan's McCauley. Some 50% of the country's healthcare networks are affiliated with at least 20 other facilities-up from 44% that had that many affiliations in the 2003 analysis.
More systems seem to be looking to fill the need for long-term-care and home health services. The percentage of U.S. nursing homes that are affiliated with a health system grew from 5.9% a year ago to 8.2%, Verispan's analysis shows. The percentage of home health agencies that belong to networks also edged higher, to just more than 10%.
Despite the maturation of many large networks, Verispan's report notes "there still is a tremendous opportunity for providers to form relationships with IHNs." It notes that 80% of U.S. physician practices are not in a network, and 58% of hospitals also remain independent.
Mike Colias is a freelance writer based in Chicago. Contact him at [email protected].
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