The University of Arkansas for Medical Sciences, Little Rock has partnered with Baptist Health in an effort to expand residency programs and to improve health in the state.
The two announced their plans to work together in a statement of strategic intent Tuesday. In part, the collaboration will include the creation of a Medicare shared-savings organization -- Baptist Health/UAMS Accountable Care Alliance -- that will identify 50,000 Arkansans who are Medicare patients and allow the two systems to measure health care delivery quality and costs to the patient, said Troy Wells, Baptist Health's CEO.
"In recent years, we have built trust and respect between our organizations by working together to improve care delivery across a number of clinical services," the statement said. "Our work together has confirmed our ability to strengthen the quality, breadth and cost efficiency of our clinical programs for the benefit of those we serve. These early successes motivate us to explore where we might take our collaboration to a new level to deliver to our constituents a broader range of benefits across our patient care, educational and community service missions."
UAMS had started down a similar road in 2013 with CHI St. Vincent. But the Denver-based Catholic Health Initiatives was interested in forming a combined clinical enterprise with UAMS, said Leslie Taylor, UAMS' vice chancellor for communications and marketing, and the state's academic medical center couldn't agree to that.
Tuesday's agreement states that UAMS and Baptist Health will remain separate institutions but will work "to offer a wider range of educational opportunities and to deliver clinical care more efficiently and effectively than either institution can do on its own."
As part of the educational opportunities, the two plan to add 117 new residency slots over time, said Stephanie Gardner, UAMS' interim chancellor.
Medical school students need postgraduate education, typically a residency, before earning a license to practice.
Nationwide, the schools have increased enrollment by nearly a quarter since 2002 as a response to an impending physician shortage. A study commissioned by the Association of American Medical Colleges estimated that by 2030 there would be a primary-care physician shortage of between 7,300 and 43,100, and in specialty areas of between 33,500 and 61,800.
Residency slots haven't kept pace with the increase in medical graduate students. The problem is also exacerbated by the bottleneck from a federal cap placed on fiscal support of the programs.
Residents' salaries are paid by the hospital, which can later be reimbursed through federally funded Medicare. Congress placed a cap on the federal fiscal support more than 20 years ago, limiting the number of residency positions across the nation, according to the medical college association. The cap does not apply to hospitals that have never previously participated in residency training.
That's why others, including the New York Institute of Technology's College of Osteopathic Medicine's campus at Arkansas State University, have helped raise the number of residency slots in a state with historically poor health outcomes. Some, including St. Bernards Healthcare in Jonesboro, are self-funding new slots.
The new slots through the alliance will be at Baptist Health Medical Center-North Little Rock and will start with family medicine and internal medicine, leaders of the two said.
UAMS and Baptist Health College also have formed an educational consortium with the University of Arkansas at Little Rock and the University of Arkansas-Pulaski Technical College. The group is hoping to ease transfer from one program into another, avoid duplication and share expertise, Gardner said, such as sharing training on using electronic health records or on certification for the Health Insurance Portability and Accountability Act, known largely as HIPAA.
"Not necessarily sharing instruction, but those things that accompany it," she said. "But also experiential opportunities, so those things that the Baptist Health System and UAMS and all our regional programs, there are a lot of different campuses in specialty as well as primary care practice that students can be exposed to if we work together."
In terms of clinical services, both entities are reviewing ways to leverage current and new resources to improve quality of care, safety and access while reducing health care costs for patients.
The two jointly filed in July for a Medicare shared-savings accountable-care organization with the Centers for Medicare and Medicaid Services. The federal agency describes the organizations as groups of health care providers that coordinate care, ensuring patients get the right care at the right time and avoiding duplication of services. They started as a way to change the payment models from quantity of services provided to one more focused on health outcomes.
Kaiser Health News in 2015 reported that from the previous year the organizations saved a total of $411 million but recorded a net loss of $2.6 million after paying bonuses. At the time, experts were across the board on whether the program would work, according to the Kaiser report.
Organizations that hit 31 benchmarks on quality and cost are eligible to keep a portion of that savings, said Taylor and Mark Lowman, Baptist Health's vice president of strategic development.
As of January, there were 480 shared savings accountable-care organizations across the nation -- including three in Arkansas -- that were serving more than 9 million Medicare beneficiaries, the agency reported.
UAMS and Baptist Health leaders are expecting to hear back on whether they will be a part of the program in the next few months. If so, the accountable-care organization will have access to health care-related data on 50,000 Arkansans who are also Medicare beneficiaries, start analyzing the data and then form strategies to improve, Wells said.
As an example, he said, the hospital system can track how many times a patient has come into its own emergency room for clinical care, but cannot currently track how many times the patient also goes to UAMS' emergency room. With the accountable-care organization, they will have access to that information, he said.
"Effective care management is really being a part of that patient's experience across the whole continuum of care," he said. "It's more of a relationship with the patient instead of an encounter."
The two are also talking with Arkansas Children's Hospital, Arkansas Blue Cross Blue Shield and Fort Smith-based Bost Inc. about creating Arkansas Advanced Care, a similar structure of the savings accountable-care organizations but on the state level. The structure was created by the state legislature this year to manage Medicaid costs for eligible patients with behavioral health and developmental health disabilities, according to a news release.
If the state chooses three of these types of organizations, each entity will likely have 10,000 patients, Gardner said.
Boards for both entities will need to approve the new organizations.
The collaboration is not the first for Baptist Health and UAMS.
Their partnership started in the early 1980s with inpatient rehabilitation and later in 2013 with vascular surgery. They've since expanded the clinical collaboration areas this year in maternal-fetal medicine and anti-microbial stewardship and in emergency medicine and orthopaedics at Baptist Health Medical Center-Conway.
The two -- along with Washington Regional Medical System, St. Bernards and Arkansas Blue Cross Blue Shield -- formed a shared services organization last year. Called the Partnership for a Healthy Arkansas, the organization allows the groups to share certain services, such as information technology and call centers, but continue to maintain their independence.
"I think collaboration is really important in health care if we want to achieve what we're talking about here...," said Wells, the Baptist Health CEO. "Arkansas is a rural state, relatively small state. It's important that UAMS continues to have better and better opportunities for training the caregivers of tomorrow. It's important that both health systems work to grow educational opportunities, and it's important that we both work towards providing the very best care for the people of Arkansas.
"And we do that by leveraging resources, by looking at what both organizations have to offer and try to build those things together and make it better for people."
Metro on 08/30/2017