The Membership Organization of State Offices of Rural Health
Rural Health Network Development and Benchmarking for Performance Improvement – Michael Topchik
Corporate sponsors are not only an important resource for funding for the mission of NOSORH, they are experts in rural health and often partners to the State Offices of Rural Health. This important work will be featured in a series of articles over the next few months.
Many NOSORH members are familiar with iVantage Health Analytics as the analytics firm powering the NOSORH Performance Leadership recognitions. The company’s Hospital Strength INDEX® is the basis of many of rural healthcare’s most prominent awards and is used by organizations such as NOSORH and NRHA in support of their advocacy and legislative initiatives.
Each year, iVantage Health Analytics develops the Rural Relevance Study: Vulnerability to Value, as a means of quantifying the rural hospital value proposition and offering analytic transparency around the landscape’s defining factors. Today’s rural hospital leaders face unprecedented complexity and uncertainty, and iVantage has helped more than 750 rural and CAHs integrate sophisticated analytics for benchmarking performance, which aid in their strategic decision making process. iVantage helps hospitals deliver high quality care at low cost to maintain their status as the cornerstone of their communities.
iVantage has a strong track record in numerous states for providing detailed reports to state partners to satisfy Flex grant requirements. They have developed proprietary technology to aggregate individual hospital performance data into simple, easy-to-read reports for state partners that exceed grant requirements and provide valuable local and national benchmarks for use in network meetings and other activities.
Since 2009, iVantage has been working with the Ohio State Office of Rural Health (OHSORH) through the Ohio Department of Health (ODH) to develop an Ohio CAH network collaborative centered on performance benchmarking, monitoring and improvement. Ohio CAHs perform above the national benchmarks in almost all areas of focus, including Quality and Financial performance. iVantage’s work with the OHSORH helps support the exceptional performance of the 33 CAHs across the state of Ohio. A CEO/CFO work group for Financial and Operational Performance Improvement was also developed in Ohio in order to “move the needle” and to realize improvement to the bottom line. Financial data on all Ohio CAHs was captured and a monthly data feed was instituted, serving as a jumping off point for the true performance improvement work to follow. National, regional, state, and hospital-specific benchmarks were created and targets were established for improvement. Based on the findings, the CEO/CFO work group determined cost efficiency and productivity as well as revenue cycle improvements through managed contract optimization.
One Ohio CAH in particular, The Morrow County Hospital, has embraced benchmarking data to plan and execute at both a local hospital-level and at a network-level. iVantage has helped Morrow County Hospital target under-performing measures (Benefits, Supplies, Lab, Productivity, etc.), removing as much as $1,500,000 in excess cost, without mandates. This type of work is paramount to preparing Ohio CAHs for Cost Transparency, which is critical in the new health care environment.
“Intuitively, you always think you can do better. But actually putting your finger on where the opportunity might lie was difficult. With iVantage, we’ve been able to compare ourselves to other like hospitals,” said CJ Miller, President and CEO of Morrow County Hospital.
Thanks to iVantage for their ongoing support and to the Ohio Flex Program (funded by the Health Resources and Services Administration (HRSA), Federal Office of Rural Health Policy) for sharing these examples of great collaboration.
Corporate sponsors are not only an important resource for funding for the mission of NOSORH, they are experts in rural health and often partners to the State Offices of Rural Health. This important work will be featured in a series of articles over the next few months.
For over a decade, State Offices of Rural Health have committed significant time and resources toward developing statewide Critical Access Hospital performance improvement networks. Likewise for over a decade Stroudwater Associates has supported the work of NOSORH and State Offices of Rural Health. . The result of this effort and focus has been the formation of mature, effective networks that enable CAHs to learn from one another, share performance data and collaborate on improvement projects.
“Stroudwater is proud to support the mission and goals of the National Organization of State Offices of Rural Health. In a rapidly changing environment with increasingly vulnerable rural providers and communities, we feel it is essential that organizations such as NOSORH continue to play a central, vital role in coordinating resources for state partners, hospitals, clinics and providers,” says Gregory Wolf, Principal with Stroudwater Associates.
Stroudwater Associates is a private healthcare consulting firm with corporate offices in Portland, Maine, Atlanta, Georgia, and Nashville, Tennessee, and experience working in all 50 states. Their Rural Team is passionate about the health of rural people and places. They tout their belief in relationship development, collaborative strategies, and commitment to personal learning and growth; with roughly half of their national practice committed to rural provider organizations.
Stroudwater supports nearly a dozen State Offices of Rural Health on their statewide performance improvement activities. Two SORH who recently shared their work on convening rural hospital networks that have a common partnership with Stroudwater Associates are the New York and Massachusetts Flex Programs.
In New York State, the Flex grant provides funding for a comprehensive performance improvement network that integrates Quality and Financial benchmarking, technical assistance and rapid-cycle projects for all of the state’s 19 CAHs. Every quarter the CEOs, CFOs and Quality Improvement Directors from every CAH across the state meet for a one-day Improvement Summit where market trends and updates are shared, state and national benchmarks are analyzed, and breakout sessions for collaborative improvement projects are convened. The New York SORH and Stroudwater partner on agenda development, meeting facilitation and methods for spreading the findings generated from the rapid-cycle project management process, the cornerstone of the Learning and Action Network. Karen Madden, the SORH Director and past NOSORH President, has witnessed the evolution of the CAH network: “Over the past several years we’ve seen increased involvement from all of our CAHs where we have almost 100% participation at every meeting from multiple managers from every hospital. But the most important advance for us has been the work that happens between our meetings. With the full implementation of the Learning and Action Network, the CAHs now work on collaborative improvement plans throughout the year and use the network meetings to learn from one another and share their successes. The level of engagement, accountability and improvement from our CAHs has been truly transformational.”
In Massachusetts, the Office of Rural Health faces a unique set of opportunities and challenges. The Commonwealth has a relatively small number of rural hospitals, most of those facilities are owned by large urban health systems, and two of the CAHs are located on islands. How does the Massachusetts SORH navigate this complex environment? “Our team has to be creative, flexible and highly collaborative,” states Cathleen McElligott, the SORH Director. “When we do our CAH network planning and consensus building with CEOs it’s essential that our Flex program activities factor in geography, hospital ownership and our state’s dynamic health reform environment. Stroudwater plays a key role in that process because they offer not just rural expertise, but also a higher level of credibility and knowledge to help our CAHs define and communicate the strategic relevance of our network activities to the health system leadership.” Like their counterparts in New York, the Massachusetts CAHs meet for full-day Improvement Summits throughout the year to review comparative analytics, address strategic and operational priorities and collaborate on rapid-cycle improvement activities.
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