Innovative Collaborations

Melissa Scott, Senior Managing Director with GlassRatner's health care industry group, speaks to Jennifer Willcox, Vice President of Legal Services, Yale New Haven Health System, and Rebecca Matthews, Wiggin and Dana LLP, about their presentation at AHLA's 2019 Annual Meeting in Boston regarding innovative collaborations between hospitals and health centers. Sponsored by GlassRatner.

To learn more about AHLA and the educational resources available to the health law community, visit americanhealthlaw.org.

Transcript

MS: 0:00

Hello, I'm Melissa Scott, Senior Managing Director with GlassRatner's Health Care Industry Group. As part of AHLA's Expert Insights podcast series, I'm here with Rebecca Matthews and Jennifer Willcox at AHLA's Annual Meeting in Boston. They're presenting a session entitled,"Promoting a Paradigm Shift in Primary Care: Innovative Collaborations Between Hospitals and Health Centers." Rebecca and Jennifer, I'm excited to talk to you both about this topic today. Do you want to start by telling a little bit about yourselves and your practice?

JW: 0:27

Sure. This is Jennifer Willcox and, first, I want to thank GlassRatner for this opportunity and sponsoring this podcast. I am Vice President of Legal Services at Yale New Haven Health System. We are a five-hospital academic health system in southern Connecticut, western Rhode Island, and Westchester County. We also have a significant physician foundation. And prior to joining Yale New Haven, I was outside counsel at several firms representing hospitals within Yale New Haven Health System.

MS: 0:55

Excellent.

RM: 0:56

I'm Rebecca Matthews. I am a partner Wiggin and Dana. We're a regional firm with offices in Connecticut, New York, Pennsylvania, DC and Florida. My practice focuses on health care, specifically transactions and regulatory matters in health care transactions, mostly with hospitals and academic medical centers. I am lucky enough to work with Jennifer on a number of projects, and we're happy to be here.

MS: 1:20

Great. Well, I appreciate you both taking the time to sit with us and talk to us a little bit more about this topic. Can you tell me one thing from the session that you'd like attendees to take away?

RM: 1:31

So, I think we're going to cheat and probably each take one or two things. I think one thing I hope people take away from the project or from our presentation is to really consider, the fact that there can be a lot of competing rules and it's sometimes threading a needle, trying to find out the best way to address issues that are, that may be conflicting. We talk a lot about how the federal rules have one bent and then the state regulators might need something else and kind of coming up with a balance. The other thing I hope people take away from it is planning, planning, planning. And despite all of our planning, we still had curve balls. But planning and collaboration is really, really incredibly important. And, you know, trying to really think about what might come up and collaborating with people in advance on making sure all the stakeholders are heard.

JW: 2:28

Yeah. And I would just add to that that on the collaboration, even though I represented, I was the in-house counsel representing the hospital in this transaction, I always had to keep the interest of the FQHCs- even though they were technically the adversaries or the other parties- we had to be aware of their particular requirements. We had to keep bringing them to the table. We had to be sure they understood what we were doing, constantly communicating with them. And they also had a pretty reduced budget. So whereas with a sort of parallel organization, you would just go to their lawyer and you could have your conversations- we had to speak directly to the business leads a lot of times and to the physicians at these FQHCs. So that collaboration and that communication, keeping those channels opened, the way you speak, that was very important.

MS: 3:07

What one piece of advice would you give a hospital or health center contemplating a collaboration agreement?

JW: 3:13

Again, I'm going to cheat, probably, with a couple pieces of advice, even though I don't bill by the hour; an outside lawyer bills by the hour. So, I don't have the incentive to speak at length, but I think one piece of advice is that the collaboration is very important. And from the lawyer's perspective, being very aware of what is going on, on the operational side as well. I mean, so we drafted this nice collaboration agreement, but there were so many legal issues that came up associated with how the building was being designed, the workflow for the patients, the staffing model, you know, how the residents would interact. So, it's not enough to just stay in your legal lane and say,"oh, I'm going to do the documents." You really have to understand what the clinical leaders are trying to accomplish. Remind them of the legal guardrails for that. And really stay involved at an operational and an implementation level.

MS: 4:04

One of the factors you mentioned is that the collaboration must improve overall care for patients by preserving the best of each current model. Is that hard to measure?

JW: 4:12

Yes.

MS: 4:15

How should an entity thinking about collaboration go about showing care improvement?

JW: 4:19

Well, one of the factors of the collaboration that Rebecca and I spoke about is we're moving two FQHCs onto the Epic electronic health record. Our hospital is already on Epic and that will give us just much more ability to dive into the data, to do data analytics to track things. But you know, it is still going to be an uphill climb trying to figure out what we measure. Are we measuring the right things? I think we'll be able to look at, you know, reduced ED visits- we're hoping to see that- reduced utilization of, you know, high end imaging, because we'll be able to reduce the duplication and have more insight and direct line of sight into the care provided to all of these patients. But it's going to be challenging, you know, beyond that, beyond utilization and efficiency. First, we're all going to have to agree on what does it mean to improve care and that's part of what the physician steering committee has been doing and part of the operations team for this project. Okay, can we all agree on what are the goals we're trying to meet and the goals we're trying to improve? Is it getting, you know, behavioral health screenings, you know, per number of visits? Is it, you know, diabetics getting their foot exam and how that's going to be documented? So we need to get folks to agree on those things that constitute an improvement in care and then figure out how we're going to measure them. Rebecca, do you have anything to add?

RM: 5:33

No, I think that's very helpful. I think there is a lot of room still to grow on determining how you can measure care improvement, and it's going to be difficult. But as Jennifer said, the parties are really dedicated to it and are going to be looking at different metrics and continually evaluating and reassessing.

JW: 5:54

And I think it is a very innovative collaboration. I know we've heard the word innovation probably in the title of half the sessions here, but I do think we're looking at new ways of collaborating with health centers and not just picking up our primary care center and handing it over to an FQHC. We really are trying to create that ongoing collaboration. And so I think we're going to, when we talk about measuring care improvement, some of the criticisms about the metrics that are used now or that, you know, those five care standards, they're easy to measure, but they really don't measure what's going on with patients. So I think our innovation is going to have to continue as we figure out ways looking at these specific patient populations. And looking at their specific needs. What do we really want to measure rather than you know, just the HCAHPS or the HEDIS or the other sorts of quality metrics that are out there.

RM: 6:38

And I think this probably goes back to the prior question, but in terms of hospitals and health centers contemplating a collaboration, I think Jennifer has said it so well in terms of really focusing on the patients and focusing on the overall goals. And, you know, no party came into this without thinking about the perspectives of the others. And Jennifer said it very well in terms of the hospital that is constantly thinking about what is the perspective of the health centers, what is the perspective of the patients. Because this is something that, you know, everybody wants to do together for a particular purpose. And so nobody's sort of coming in with a specific agenda without considering the aspects of the other stakeholders.

JW: 7:16

Right. And the lawyers have to have that as well, not just the operational and the business leads. They have to be thinking about the needs of the patient and kind of keeping that at the front and center. It can't just be about economics. If the hospital's going into this thinking,"oh, we're going to save money by doing this" and that's end of story, then they're not going to get very far. The patients do have to be at the center of it and the unique needs of the health centers and the physician partners as well.

MS: 7:37

Do you have any other key takeaways or pearls you'd like to share with your AHLA colleagues on this topic?

RM: 7:43

I think everybody has their sort of checklists of regulatory considerations, and we provided a really long one for an arrangement like this.

JW: 7:53

I think that one of the takeaways is that we've used a variety of different law firms, so people bring different things to the table. We have one law firm that's expert in FQHC law and that's been crucial. Rebecca has been great on the transaction and the state approval side. But it's recognizing you need different levels of expertise. And so, if, you know, health care lawyers, particularly an outside practice, have a particular niche or can position themselves that way, you know, we've had to work with a variety. We've worked with one lawyer for one of the FQHCs who is essentially really a real estate lawyer because they see this as a real estate transaction in a lot of ways, but it turns out she has a background in FQHC and bond financing as well. So she's been a very useful partner too. I think the lawyers have been very collaborative. I think that's one thing that has made this possible, is that as we're focusing on collaboration, we have been collaborative on all sides.

MS: 8:43

Well, I think that's great feedback. Thank you both so much for taking the time to chat with me. And that's a wrap.

JW: 8:48

Thank you.