After five years, Together Health Network, an ambitious effort by three of the leading health systems in Michigan to contract with payers and employers and achieve shared savings for its hospitals and doctors, has closed down, Crain's has learned.
Together Health was formed in 2014 by Warren-based Ascension Michigan and Trinity Health of Michigan in Livonia. Michigan Medicine, part of the University of Michigan in Ann Arbor, joined in 2016. Participating also were the health systems' 29 hospitals, several dozen post-acute care facilities and more than 5,500 physicians.
Conceived as a clinically integrated network, physician-led Together Health was never able to achieve optimal performance and an adequate return on investment hoped for by physicians and participating health systems, two sources with knowledge of the matter who asked for confidentiality told Crain's.
In a statement, Together Health Network confirmed it would cease operations in July. Its website at www.togetherhealthnetwork.org has already been deactivated.
"The health systems and physician organization providers will continue their respective efforts to deliver high value, accessible care and an exceptional patient experience through their individual initiatives," the statement from Together Health said.
Together Health was led by Scott Eathorne, M.D., a family and sports medicine physician, since its formation in 2014. Eathorne referred comments about the network to the corporate offices of Trinity and Ascension. He said he plans to continue his clinical practice and consider other opportunities.
Eathorne formerly was president of Partners in Care, a physician hospital organization representing the partnership between 2,100-member The Physician Alliance and five-hospital St. John Providence Health System, a subsidiary of Ascension Health.
One of Together Health's advertised advantages to payers and employers was that its 29 hospitals, ambulatory care centers and physician offices were within a 20-minute drive of 75 percent of Michigan's 10 million residents.
Of the nation's estimated 500 clinically integrated networks, some are struggling to coordinate care under what are known as "value-based" contracts, which reward participants for lower costs and higher quality over time, said the Advisory Board, a Washington, D.C.-based health care research group.
Sources told Crain's that Together Health closed because it was unable to generate enough shared savings to convince enough participating doctors to make sufficient clinical changes in their practices in order to reduce costs.
"It is very difficult get a lot of doctors in a room and have them agree on (standardized clinical) metrics," said one source familiar with the Michigan market for health care contracting who asked for confidentiality. "Clinically integrated networks are a good idea and many are working around the country.
"You have to start out slow in the beginning, like Blue Cross (Blue Shield of Michigan) with its physician group incentive program, and slowly push the money out to the doctors. The money has to be sufficient for them to pay attention to the changes. There is a certain threshold (on bonus payments) that has to be met so they know it is worth doing. If you don't have that, see the money coming back, it will teeter and fail."
People who have worked with integrated networks say that it can be difficult to get physicians to agree on quality metrics to be measured, and the potential financial bonuses for meeting those metrics then must be big enough for doctors to pay attention to them.
At least two other clinically integrated networks exist in Michigan. They are Kalamazoo-based Affirmant Health Partners and Beaumont Care Partners and Beaumont ACO, organizations affiliated with eight-hospital Beaumont Health in Southfield.
Affirmant includes six health care systems, 21 hospitals and about 6,000 of their affiliated physicians: Henry Ford Health System, Detroit; Bronson Healthcare, Kalamazoo; Covenant HealthCare, Saginaw; Lakeland Health , St. Joseph; MidMichigan Health, Midland; and Sparrow Health System, Lansing.
Spectrum Health, a Grand Rapids-based health system with 12 hospitals, dropped out of Affirmant in 2017.
Affirmant has at least one shared savings contract with Medicare under an accountable-care organization format.
In 2016, the University of Michigan joined Together Health as a referral provider for complex inpatient and outpatient medical cases, also known as quaternary care. These services include transplant services, highly specialized pediatric care and cancer clinical trial services that were unavailable at Ascension Michigan and Trinity Health facilities.
UM did not respond at deadline for a comment. Neither did Trinity, another parter, Blue Cross or Priority Health, which contracted with Together Health at one time.
Together Health signed a number of managed care contracts, most of which were geared at giving financial incentives to improve quality in exchange for lower costs through care coordination, using electronic health records and team-oriented care approaches.
It is not known how many of the contracts were successful, if any, but some included:
- In 2018, Priority Health signed a "narrow network" contract with Together Health called Southeast MI Partners. It offered Priority's managed care members Together's providers in Wayne, Oakland, Macomb, Livingston, Washtenaw and St. Clair counties. Members will also pay lower out-of-pocket costs if they choose certain hospitals and doctors in the network.
Priority Health has also signed similar narrow-network contracts with Beaumont Health, St. Joseph Mercy Health System and Ascension Health and participating doctors.
- In 2017, a value-based contract was signed with MeridianHealth, a Detroit-based managed care organization and the state's largest Medicaid health plan, which allowed about 60,000 of Meridian's Medicaid members to access care with Together Health's providers through a new value-based contract that would pay for quality.
The contract was designed to pay Together Health on a fee-for-service basis, measuring various quality and cost metrics and sharing cost savings over a two-year period. Meridian has since been sold to WellCare Health Plans of Tampa.
- In 2014, Together Health signed a contract with Blue Care Network for a Medicare product called ConnectedCare in Genesee, Kalamazoo, Livingston, Macomb, Oakland, St. Clair, Washtenaw and Wayne counties.
"Ascension-Trinity medical network Together Health closes after five years" originally appeared in Crain's Detroit Business.