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Medical care in Spokane faces future boldly

Group Health and Providence will cooperate in pursuing the kind of efficient, holistic care envisioned by the Affordable Care Act.
Providence Sacred Heart Medical Center & Children's Hospital in Spokane

Providence Sacred Heart Medical Center & Children's Hospital in Spokane

Group Health Riverfront Medical Center in Spokane

Group Health Riverfront Medical Center in Spokane

In an unusual partnership, a nonprofit health plan that employs its own doctors is joining with a major Catholic hospital system in the Pacific Northwest to provide more efficient health care services to members of all health plans in the Spokane area.

Seattle-based Group Health Cooperative and the 32-hospital Providence Health & Services announced Wednesday (Aug. 1) that they have formed a joint venture to offer a single delivery network in Spokane to all health plans and employers that want to contract with them.

The goal is to expand Group Health’s patient-centered medical home model to the broader community and reduce preventable hospital readmissions and other wasteful services. The medical home model features primary care physicians leading a team of nurse practitioners and other professionals in providing for all the patients’ health care needs.

Physicians, hospitals, insurers, and employers across the country are teaming up to try to control medical costs and improve quality of care through new models called accountable care organizations (ACOs). The Spokane collaboration resembles an ACO in that the partners will share responsibility for meeting cost and quality goals for insured patient groups. But it’s unique because a health plan’s staff physicians are involved.

While many joint ventures between hospitals and health plans failed in the 1980s and 1990s, they have a better chance of succeeding now because the players are more realistic about the need to control costs, said Peter Kongstvedt, a McLean, Va.-based health care consultant.

The new company will meld Group Health’s 119 primary care and specialty doctors and other professionals in 16 locations with Providence Medical Group’s 276 doctors and professionals, Providence Sacred Heart Medical Center & Children’s Hospital, and Holy Family Hospital into a single network. It will comprise nearly 40 percent of all doctors and advanced practitioners in Spokane.

This is the first time Group Health, a consumer-governed, staff-physician model HMO founded in 1947, with 660,000 members in Washington and Idaho, will make its physicians and clinics available to commercial subscribers of other health plans.    

Providence officials hope the joint venture will enable their hospital system — Spokane’s largest, with 65 percent of the market — to position itself for an expected shift from fee-for-service payment to global payment for managing patients’ health. Both public and private insurers are moving in that direction. “This is part of Providence’s effort to move away from fee for service to payment for value and outcomes,” said Mike Wilson, head of the eastern region for Providence, which operates in five states in the Northwest.

Mike Foley, a Group Health spokesman, said the Spokane partnership is part of Group Health's continuing effort to work with partners in each local market to make care more cost-effective and reduce hospitalizations and emergency department use. It's also collaborating with the Everett Clinic in Snohomish County and with the Franciscan Health System in Tacoma.

Like other hospital systems, Providence bought many outpatient physician practices in Spokane over the past several years and is working to organize those doctors into a seamless delivery system with its hospitals. Group Health, with its long experience in working with physicians, is expected to help with that.

"Our experience is having an exceptional acute care system, and what Group Health brings is a strong historic program of managing care well in the outpatient world," Wilson said.

Kelly Stanford, Group Health’s vice president for business development in Spokane, said "a couple" of health plans already have expressed interest in contracting with the new network.

Kongstvedt said the partnership could bring benefits to both sides. "It makes sense for Providence to look to Group Health to organize its doctors and manage issues of productivity and cost," he said. "That’s something Group Health knows how to do, and that large hospital systems really underestimate."

Group Health officials acknowledge that while the medical home approach in its staff-run, primary-care-oriented clinics has produced lower costs and higher patient satisfaction, the organization has struggled to achieve the same results working with independent doctors outside its clinics.


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Comments:

Posted Fri, Aug 3, 9:49 a.m. Inappropriate

Good news. But this isn't quite right, is it?

This is the first time Group Health, a consumer-governed, staff-physician model HMO founded in 1947, with 660,000 members in Washington and Idaho, will make its physicians and clinics available to commercial subscribers of other health plans.

Perhaps something like "on the same terms as if those patients were members of Group Health itself"? I've been going to Group Health my entire life, and that includes when I was working for companies who did not offer Group Health membership as a benefit. Group Health was always more than happy to accept third-party insurance, just not on the same terms (I had to pay higher coinsurance than I would have if I'd been on a Group Health plan).

Posted Fri, Aug 3, 11:45 a.m. Inappropriate

Benjamin, good point. But as you seem to recognize, there's a major difference between Group Health accepting someone's insurance for fee-for-service reimbursement and Group Health having a contract for its clinics to serve as the preferred provider network for other health plans. Group Health said this is the first time it will be making its staff network available as a contract network for other plans.

Posted Fri, Aug 3, 11:47 a.m. Inappropriate

I should clarify, first time it's making it's staff network available as a contract network for commercial subscribers of other plans. In July it started serving Medicaid beneficiaries who are members of Molina.

Posted Sun, Aug 5, 11:01 a.m. Inappropriate

Will Group Health be forced to adhere to Providence's regulations regarding birth control prescription and abortion coverage? That very important point is not even mentioned.

sarah90

Posted Sun, Aug 5, 11:47 a.m. Inappropriate

sarah90, you must have missed the last paragraph of my article, which raises those questions, albeit briefly due to length constraints for Kaiser Health News.

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