WVUHS Develops Plan to Regionalize Services for Geographically Isolated Population

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Christopher-Colenda-thumbChristopher C. Colenda, MD, MPH, President and Chief Executive Officer

West Virginia United Health System (WVUHS) has a tough mission, particularly in today’s healthcare market: to serve a typically underserved population that is geographically dispersed.

The not-for-profit health system is the second-largest employer in the state and serves north central and eastern West Virginia, mainly the mountainous region between the Potomac River and the Ohio River.

The system consists of six hospitals throughout northern West Virginia from the Potomac River in the East to the Ohio River in the West. WVUHS includes the academic medical center of West Virginia University Hospitals,the state’s major safety-net hospital that has a children’s hospital, behavioral-medicine facility, and a trauma center; a multi-specialty ambulatory center; and an over 450-member faculty practice plan. The other community hospitals in the system have networks of owned physician practices or tightly aligned staff physicians and providers.

Developing a strategic plan under new leadership

Christopher Colenda, MD, MPH, stepped into the role of president and chief executive officer six months ago and has undertaken the development of a three- to five-year strategic plan. Before becoming CEO of WVUHS, Colenda served as chancellor for health sciences at West Virginia University, which placed him on the board of the health system for five years. He continues to serve in that role until his replacement is named.

Key elements of the system’s strategic plan are to optimize system organizational and business structures, expand services and improve access to care across the state, generate alignment among physicians, and determine an approach to the risk and insurance side of care delivery.

“We need to think about how to best optimize our structure to eliminate unnecessary duplication of infrastructure and align business practices including our brand. We need to determine what our expansion strategy should be, not only in terms of facility growth and acquisition, but more importantly, how we build a deeper primary and specialty care presence across the continuum of care in both our primary and secondary markets to meet the needs of our population, as well as our financial and academic responsibilities,” Colenda said. “West Virginia is a rural state and our patients have traditionally had challenges with access to care and health disparities. I am focused on ways to reduce disparities, improve access, and improve quality for people not typically the beneficiaries of those services.”

Expanding and remaining financially secure are extremely difficult goals to balance for WVUHS. The system has high levels of Medicare, Medicaid, and self-pay patients, which requires the board and CEO to be involved in local and state government to advocate for patients.

“Government organizations within the state fund much of our mission through Medicaid and the state insurance plan,” Colenda said. “The state extended Medicaid, which was good for the residents. It allowed more people access to coverage and reduced our charity-care burden. Early results of the impact of Medicaid expansion have shown increases in Medicaid gross charges and a reduction in self-pay patients among those who seek services at WVUHS.”

Creating alignment with physicians across the region

The system has a mix of university faculty, private physicians, and employed physicians and is always seeking ways to coordinate services across the continuum of care. Colenda said he has recently seen an increase in younger physicians seeking employed relationships with the health system, and part of the strategic plan includes recruitment, retention, and building greater provider depth and alignment of physicians in primary and secondary markets.

“We make sure our employment relationships reward physicians with benchmarking compensation for quality as well as productivity,” Colenda said. “We are developing a menu of opportunities for alignment, whether through employed relationships, strongly aligned relationships, or faculty physicians.”

WVUHS has also developed joint ventures between several hospitals to improve specialty services and has developed attractive recruitment packages for specialists and primary-care physicians. Given the challenges of recruiting talent to underserved areas, Colenda said those packages have been fairly successful.

Managing risk and building on successes

With the insurance and managed-care side of the industry changing, Colenda said determining a strategy for risk is an important part of the system’s future. “Typically, the system has focused on strategies that reward market share and clinical volumes. We simply must understand how to develop appropriate strategies and system-wide implementation plans on risk assumption for patient populations served by the system. In so doing, we will need to adapt to some form of shared-risk arrangement with the insurance industry.

“Right now there is a lot of push and pull between providers and insurance companies,” he added. “As the largest West Virginia healthcare system, incentivizing alignment of providers, facility administrators, payers, and patients that rewards cost-effective, patient-centered, evidence-based, and quality-driven care in a rural state with significant access challenges is the holy grail for WVUHS.”

Looking forward, Colenda is submitting strategies for all of the system’s goals to the board for approval and expects to have an implementation plan in place soon. He keeps a details-oriented focus on ways to build up the healthcare provided to the state with an eye on the overall effects of having a quality health system not just for patients, but also for economic development.

“Our state government and business leaders are passionate about how to expand the economic and resource base of the state,” he said. “We want to be part of that solution through delivering high-quality healthcare to those who choose us for their care.”

by Patricia Chaney

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