By JULIE MINDA
Providence Hospital of Washington, D.C., is expanding and improving upon a partnership it has with Unity Health Care, the district's largest federally qualified health center.
Under a new strategic pact, Providence clinicians will offer more specialty care to Unity patients, and the Providence clinicians will deliver much of that care at Unity locations. Also, Providence and Unity will better coordinate the way they deliver care to patients, reduce the cost and improve the efficiency of care, share best practices and an electronic medical records system, and cooperate on physician education. They also will work together on establishing new facilities.
The partners' new direction will be based on a different care model than they've used before, said the chief executives of Providence and Unity. In the past, services were delivered in a fragmented way; now the providers will use medical home and population health principles to provide care more seamlessly. That is according to Amy Freeman, president and chief executive of the 408-bed Providence, and Vincent Keane, president and chief executive of Unity. The private, not-for-profit Unity includes 12 health centers, 10 satellite locations in homeless centers, three in schools, two in jails and a mobile clinic. Unity serves more than 101,000 patients — 90 percent of them with an income below the federal poverty level.
In time the affiliation could evolve into an accountable care organization or similar type of integrated network, Freeman and Keane said. The organizations are not disclosing the amount they are investing to implement the affiliation agreement.
Building on a foundation Providence is part of St. Louis-based Ascension Health. The hospital has had a relationship with Unity since the late 1980s when Unity primarily served homeless people and the hospital agreed to serve Unity patients who had been having trouble accessing some physician services.
Unity expanded its patient base beyond homeless patients; and it grew. In 1996, it became a federally qualified health center, or a safety net provider that uses federal grant dollars to improve primary care services in underserved communities. About 63 percent of Unity's patients are insured under Medicaid; 6 percent, Medicare; 20 percent, the DC Healthcare Alliance insurance program; and 6 percent, private insurance. About 5 percent are uninsured.
While Unity regularly referred patients to Providence for specialty care, the organizations decided to enter into the new pact because they saw a need to improve how care was delivered to Unity's patients. Freeman and Keane said historically access to specialty care for Medicaid patients generally has been fragmented, with limited access, delayed appointments and lack of coordination as patients moved between providers. Often, these low-income patients had to find transportation to go outside their community to access specialty care. Many of these patients would go to emergency departments with nonemergency concerns. The Providence-Unity affiliation is expected to address these challenges, the chief executives said.
Specialists, near to home Providence specialists — both those that are employed and those that are contracted — now are providing care at Unity community health centers, in addition to treating patients at Providence facilities. This way, Unity patients can access specialty care in every ward of Washington, D.C.
The affiliation is giving Unity patients access to a broader range of Providence specialists than in the past, including cardiologists, endocrinologists, gastroenterologists, surgeons, oncologists, ophthalmologists, psychiatrists, and orthopedists.
Unity is contracting with Providence to "lease" those specialists on a per-session basis (each session lasts four hours), according to Keane; and Unity is billing and collecting for services provided at the Unity locations. Providence and Unity said Providence is compensating its specialists at "fair-market-value" for the services the specialists provide at Unity. According to Keane, Unity receives more generous federal reimbursements because it is a federally qualified health center, than the specialists would receive delivering care elsewhere to patients insured by Medicaid.
Improved care delivery The partners will be integrating their clinician teams by forming committees of clinicians from both Providence and Unity and by improving how the clinicians work together. The two organizations also are enabling the clinicians to share patient information. With integration and a shared medical record system, the partners expect to improve how they coordinate care, to help patients navigate the medical system better, to assist patients with follow-up and to avoid duplicated services.
Providence and Unity are working together and with payers to implement preventive health and population health programs. These include chronic disease management programs, initiatives to prevent inappropriate use of the emergency room by chronically ill people and diabetes education efforts.
The partners also are working together on physician education, including residency training at Providence.
And, the partners are in discussions to develop two new care locations in the district by 2016.
An integrated model Freeman said that using population health and medical home concepts should help Providence and Unity improve Unity patients' health and should drive down the cost of delivering care to them, which will allow the providers to have a modest margin on most of the services they deliver.
Freeman said integrating the services delivered by safety net hospitals like Providence and federally qualified health centers like Unity can transform the way patients are cared for in an urban setting. Hospitals and federally qualified centers in other markets also are using the approach, Keane said.
"This is a model for the future, on how to improve health outcomes while reducing costs," said Keane.
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