1. Increasing Consolidation in Health Care - a provider’s perspective
2016 Washington
State of Reform Health Policy Conference
Hiroshi Nakano
Director | Value Based Care

2. Why VMC and UW Medicine Affiliated
Increase access to healthcare services for South King County residents.
Improve efficiency of care; align best practice models expand clinical, teaching and research programs.
Position both organizations for future healthcare reform opportunities, such as the creation of an Accountable Care Organization (ACO).
Affiliation agreement signed in mid 2011.
Med School: University of Washington
Residency: University of Washington
Board Certification: General Surgery
Fellowship: University of Washington
Last Job: St. Luke’s
Location: Idaho

3. UW Medicine|Valley Medical Center Structure
VMC assets remained district assets.
VMC continues to offer all core and clinical services.
UW Medicine offers additional clinical services in agreed upon service gaps.
VMC employed physicians and employees remain VMC employees.
District Board of Commissioners remains on the board. New board oversees VMC management.
New board consists of:
3 UW Medicine Designated Trustees
5 Community Trustees
5 Commissioner Trustees
Two VMC Commissioners sit on UW Medicine board.
Med School: University of Washington
Residency: University of Washington
Board Certification: General Surgery
Fellowship: University of Washington
Last Job: St. Luke’s
Location: Idaho

4. UW Medicine Puget Sound Locations
UW Medicine Shoreline Clinic
UW Medicine Woodinville Clinic
Northwest Hospital
UW Medicine Residency Clinic
Seattle Children’s
UWMC Roosevelt
UW Medical Center
Hall Health Primary Care Center
VMC and its … clinic network
Seattle Cancer Care Alliance
UW Medicine Belltown Clinic
UW Medicine Eastside Specialty Center
Harborview Medical Center
Puget Sound Health Care System
UW Medicine Factoria Clinic
Airlift Northwest
UW Medicine Issaquah Clinic
Newcastle Clinic (Primary & Urgent Care)
Renton Landing Clinic (Urgent Care & Sports Medicine)
North Benson Clinic (Urgent Care)
Valley Medical Center
Fairwood Clinic (Primary Care)
Cascade Clinic (Primary Care)
Highlands Clinic (Primary Care)
Valley Family Medicine Clinic (Primary Care & Residency Program)
Occupational Health Services
Kent Clinic (Primary & Specialty Care)
UW Medicine
Kent/Des Moines Clinic
Covington Clinic North (Primary & Specialty Care) Covington Clinic South (Urgent & Specialty Care)
Lake Sawyer Clinic (Primary Care)
Valley Women’s Healthcare (OB/GYN)
UW Medicine Federal Way Clinic

5. aco Networks in Puget Sound - Commercial
UW Medicine ACO Network:
Capital Medical Center
PeaceHealth
UW Medical Center and clinics
Cascade Valley Hospital and Clinics
Seattle Cancer Care Alliance
UW Neighborhood Clinics
Island Hospital & Clinics
Seattle Children's Hospital
UW Physicians
​MultiCare Connected Care
Skagit Regional Health
Valley Medical Center and clinics
Overlake Medical Center
Harborview Medical Center and clinics
Proliance Surgeons
Northwest Hospital & Medical Center and clinics
Multiple physician practices ​
Providence-Swedish Health Alliance:
Providence Regional Medical Center Everett
Swedish Ballard
Proliance Surgeons
Providence St. Peter Hospital
Swedish Edmonds
The Polyclinic
Providence Centralia Hospital
Swedish Issaquah
Overlake Medical Center
Swedish First Hill
Skagit Regional Health
MultiCare Health System
Swedish Cherry Hill
Minor & James Medical
Multiple physician practices
Pacific Medical Centers (PacMed)
Med School: University of Washington
Residency: University of Washington
Board Certification: General Surgery
Fellowship: University of Washington
Last Job: St. Luke’s
Location: Idaho
Puget Sound High Value Network:
Edmonds Family Medicine
Evergreen Health Partners
Multicare Connected Care
Overlake Medical Center
Seattle Children’s
Virginia Mason

6. Does Consolidation Impact the Triple Aim?
UW Medicine and VMC:
Access to commercial ACO contracts
Access to clinical expertise
Access to research opportunities
Sharing of best practices within the system
Sharing of best practices with community providers
Med School: University of Washington
Residency: University of Washington
Board Certification: General Surgery
Fellowship: University of Washington
Last Job: St. Luke’s
Location: Idaho

7. Are delivery systems changing? ----The VMC Experience
Changed RN Focus to Care Management (2013)
RN Care Manager Training (AAACN)
Evolved Disease Management to High Risk Holistic Care Management (2014)
Re-Aligned Quality Metrics
Re-Aligned Team Metrics
Focused on Patient Experience (2013)
Created RN Panels (2014)
Medical Home Recognition (2015)
Risk Scoring Imbedded in EMR
Healthy Planet/Registry Development
Shadowing/Teaming with IP Care Mgt

8. Challenges….
Open Medical Staff (ex % of patients seen in urgent care and specialty care have PCP out of network)
Alignment of leadership
Changing demographics: South King County increasing obesity, low income, low literacy, more diversity
Provider burn out (ex. too many clicks)
Complicated and overly prescriptive care management contract specifications
Conflicting ACO contract(s) objectives
RN Care Manager panel growth and management ( patients/RN)
And more………..

9. Challenges….
Fee For Service/Volume/Visit orientation in Shared Savings arrangements
Reliance on downstream revenue
How to fund population management infrastructure
Pot at the end of the rainbow?
Volume based Chronic Care Management?
Capitation?

10. Challenges…
Is it getting better? You tell me.