CHP explores options to better align acute and post-acute care

October 15, 2012


Cincinnati-based Catholic Health Partners is issuing a request for purchase proposals to help determine the fate of its nine long-term care and elder residential campuses that are located far away from CHP hospitals. CHP is open to interest from both Catholic and other-than-Catholic respondents. The initiative is part of a systemwide effort to improve how CHP hospitals coordinate care delivery with long-term care providers in their regions.

"The main driving factor for this decision (to seek options for the campuses) is based on geography and our ability to fully deliver upon the care needs of our communities," said Jason Niehaus, CHP president of senior health and housing services. "CHP wants to create a systemwide approach to care, and to do that we need to be much more focused on our markets where we can offer a full continuum of care," anchored by a CHP hospital.

CHP has 24 hospitals in Ohio and Kentucky and 15 long-term care and residential facilities, including the nine located far from CHP hospitals. In recent years, CHP has been developing a strategy to organize its hospital-based regions more as integrated networks of care than as disconnected providers. To do this, each market that is anchored by a hospital is strengthening connections between the hospital and other providers in the community, particularly post-acute care service providers. It is strengthening ties both with CHP long-term care providers and providers outside the system.

As part of this strategy, and potentially beginning as early as next year, each region will form a network of acute and long-term care providers. Each such network will have a joint operating council made up of leaders from across the continuum of care who will meet regularly to discuss how to improve the way they coordinate care delivery in their communities. Councils will be looking, for instance, at how patients transition between acute and post-acute care facilities, how care teams can help patients avoid readmissions, how to measure and improve care quality and how to improve communication among facilities, among other aspects of care delivery.

When it comes to non-CHP providers, the hospitals will choose their potential partners in the regions by looking at how well the providers perform on certain quality measures, how well they meet patient satisfaction targets, their rates of rehospitalization and similar measures.

Niehaus said the networks could evolve into accountable care organizations, or some adaptation of that model of integrated care.

Niehaus said that aligning incentives and operations will enable CHP to better prepare for the dynamics of health care reform. He said providers need to be able to work together in communities or across regions to better manage population health — a key goal of health care reform.

Niehaus said that CHP long-term care and residential campuses that are distant from the system's hospitals will not fit into this geographically driven approach, and that's why the system is issuing a request for purchase proposals for those campuses this month. The campuses in question had total revenues of about $75 million in 2011. In some cases, CHP is looking at options for long-term care and residential facilities located in the same city as CHP hospitals, but not in the specific catchment areas those hospitals serve. This is the case for some Cincinnati facilities. Four of the facilities included in the request for proposals are part of joint ventures; and CHP is looking to divest its interest in those campuses.

Niehaus said in fielding the responses, CHP will be seeking to divest the campuses to organizations that can maintain the services, not close the facilities. "We believe there's a need for these services in these communities," explained Niehaus. He noted that in considering respondents' proposals, CHP will give great consideration to whether and how prospective bidders will maintain the long-term care campus' Catholic identity.

CHP will be evaluating which prospective bidders appreciate the facilities' legacy and identity, Niehaus said. "It's not just about 'who's the highest bidder.' It's about who we are most confident in, when it comes to their ability to carry on the ministry — whether or not that's with the same sponsor and the same (tax-exempt) status." He noted, however, that CHP will not restrict its options to organizations that commit to maintaining the campuses' Catholic identity.

He said CHP would be open to partnering in some way if full divestiture is not a possibility for some of the facilities. If no buyer or partner is identified for a facility, there is a possibility CHP will continue to operate it, Niehaus said.

Niehaus said that CHP's alignment strategy should help it strengthen its regional markets and allow it to focus resources on the integrated networks. He said this should enable the facilities in these regions to handle escalating challenges, such as declining reimbursements from Medicaid and Medicare. Other challenges include the need for capital investments despite tight margins and declining occupancy rates at some CHP long-term care facilities. These declining rates are in some cases related to increasing competition in some regions.

Julie Trocchio is CHA senior director of community benefit and continuing care. "The Affordable Care Act and strategic thinking on the part of health care systems are leading Catholic health organizations to take a comprehensive approach for how best to serve their patients and communities in a coordinated, cost-effective way," she said. "CHP's integrated networks are an excellent example of this."

Catholic Health Partners facilities seeking options

As Catholic Health World went to press, Catholic Health Partners planned to issue in early October its request for proposals for the following facilities, to determine divestiture or partnership options:

  • Laurel Lake Retirement Community, Hudson, Ohio — 75 skilled nursing beds,57 assisted living beds and 296 independent living units
  • Mercy Providence, New Albany, Ind. — 158 skilled nursing beds and 14 assisted living beds
  • Mercy Sacred Heart, Louisville, Ky. — 70 skilled nursing beds, 60 assisted living beds and 15 independent living units
  • Mercy Siena Retirement Community, Dayton, Ohio — 99 skilled nursing beds and 55 assisted living beds; a joint venture
  • Mercy Siena Village, Dayton, Ohio — 108 independent living units; a joint venture
  • Mercy Health – Schroder, Hamilton, Ohio — 85 skilled nursing beds and 50 assisted living beds
  • Mercy Health – St. Theresa, Cincinnati — 100 skilled nursing beds, 41 assisted living beds and 33 independent living units
  • StoneBridge at Winton Woods, Cincinnati, a patio home community for seniors, with 76 units; a joint venture
  • Winton Woods Community, Cincinnati, a housing complex for low-income elderly, with 73 units; a joint venture

Copyright © 2012 by the Catholic Health Association of the United States
For reprint permission, contact Betty Crosby or call (314) 253-3477.

Copyright © 2012 by the Catholic Health Association of the United States

For reprint permission, contact Betty Crosby or call (314) 253-3490.