Seedbed of ideas.

A national resource for facilities grappling with the realities of integrated services 

The National Chronic Care Consortium (NCCC) is a strategic alliance of 28 of the nation's leading non-profit health systems, all of which share a vision of integrated care for people with chronic health conditions, from onset to resolution. Central to this vision is the recognition that the primary business of health care is changing, from acute to chronic care. People with serious chronic conditions are health care's highest-cost and fastest-growing service group, and current administration, financing and service delivery methods are becoming increasingly ineffective in addressing their multidimensional needs.

"The nature of health care is fundamentally changing," says NCCC President and CEO Richard Bringewatt (see also "An Outline for Success," p. 29). "While, in the past, the health care industry has thought of nursing homes as being the industry for chronic care, there are now many other 'players' that are not only in the business, but are becoming more active in it. As much as 70% of medical care relates to problems of chronic disease and disabilities, so chronic care is becoming a significant business of hospitals and primary care facilities.

"No longer is it 'long-term care equals nursing home care,' or 'chronic care equals long-term care.' Instead, chronic care really covers the spectrum of primary, acute and long-term care."

The NCCC's mission is to serve as both an operational laboratory for NCCC members developing innovative care programs, and a national resource center in transforming current national care delivery systems toward improving quality while reducing costs. While NCCC members reflect the diversity of existing network arrangements nationally, each is a not-for-profit health care provider or group of providers offering a full continuum of primary, acute, transitional, nursing home and community-based long-term care services. All members are establishing chronic care networks (CCNs). CCNs are defined as person-centered, systems-oriented approaches to managing care across time, place and profession, and using integration, disability prevention and managed care financing methods.

With these members as the foundation, the NCCC serves as a national voice for chronic care integration, facilitating communication among member sites, chronic disease organizations, health care associations and other national health care system experts. The NCCC also emphasizes research and development to enhance members' ability to function as its "operational laboratories."

To assist in the transformation of health care, the NCCC has recently launched the National Resource Center (NRC) on Chronic Care Integration. The NRC provides "best-practice" technology and prototype methods for chronic care integration.

Products and services, such as an information center, consultation services and integration management tools, are made available to health networks, helping them to move beyond the merger of assets and authority, to truly integrating governance, management, programs, information, financing and clinical care for chronic diseases and disabilities. While NCCC membership is limited to not-for-profits, NRC access is open to for-profit providers.

The NCCC has mounted several specific initiatives, including:

Chronic Care Networks for Alzheimer's Disease. The Alzheimer's Association and the NCCC are collaborating to create operational models of integrated care for people with Alzheimer's disease and related disorders. Incorporating the range of services needed by affected individuals and families, these will be designed for integrated provider arrangements using managed care financing methods. Support tools and interventions will also be defined so that health networks and Alzheimer's Association chapters can improve care and contain costs throughout the course of the disease and across the continuum of care.

Partnerships between selected Alzheimer's Association chapters and NCCC members will investigate whether new integrated methods using risk-based financing arrangements can produce better health outcomes and consumer satisfaction for these patients and families. The results will be strategically important in light of the dramatically increasing numbers of families affected. by dementia who will be served by health networks under managed care financing arrangements.

A Toolbox for Integrated Care. The NRC will identify and disseminate best operational tools and methods for integrating care used by leading-edge NCCC-member and non-member providers. This "toolbox" is anticipated to include methods for integrating governance, management, information systems, finance and care management. An example is the NCCC's Self-Assessment for Systems Integration (SASI[TM]) tool. Developed under a grant from The John A. Hartford Foundation, SASI is designed to assist health care systems and emerging networks in planning, implementing and measuring chronic care integration across their operations.

SASI identifies nine essential components of chronic care integration: governance, management, information systems, financing systems, high-risk populations, full continuum services, disability prevention with an emphasis on care management, seamless care, and client involvement. Using SASI's four sections - Guidelines and Indicators, a Workbook, Global Measures, and a Resource Guide - organizations can focus on one objective at a time or work on system-wide integration efforts involving all nine.

Using SASI to Advance System Integration. With funding from an additional John A. Hartford Foundation grant, the "Using SASI to Advance System Integration" project is building upon the NCCC's experience in developing SASI and other practical tools for integrating care. To this end, the NCCC will closely examine the process and progress toward integration through the use of SASI at five project sites across the country.

Minnesota Senior Health Options Project. The NCCC Resource Center is working under a contractual agreement with the State of Minnesota to provide technical assistance, best-practice tools and resources to health plans and provider systems in support of the Minnesota Senior Health Options (MSHO) Project, a pioneering health care program for Medicare- and Medicaid-eligible seniors (see also "Long-Term Care's Brave New World," Nursing Homes 1996 (November/December), p. 28). Minnesota is the first state to offer a program that helps seniors receive the health care and support services they need across a coordinated continuum of care. Now in its pilot stage, it is sponsored by the Minnesota Department of Human Services and partnering health plans.

To help with the MSHO program, the NCCC Resource Center will develop and implement the MSHO Technical and Educational Assistance Program (TEAP), under the oversight of State of Minnesota staff. TEAP will focus its efforts on expediting clinical integration, care management and coordination of services across providers and care systems.

National Conference. The NCCC's second national conference, "Transforming Care Delivery: Bridging Concepts and Practices," will be held this year in Minneapolis, September 21-23. The conference will focus on practical strategies for integrating care and transforming delivery systems, with an emphasis on people with serious and disabling chronic conditions. Best practices and real-life experiences with integration strategies will be highlighted and shared.

National Publication. NCCC's "Chronicare Networks" will be published six times per year. The 12-page publication will provide readers with current information and references on integrated care for people with serious and disabling chronic health conditions. Each issue will focus on practical, state-of-the-art information pertaining to one key component of integration.

RELATED ARTICLE: An Outline for Success

by Richard Bringewatt, President and CEO of the National Chronic Care Consortium

Managed care is rapidly being applied to the financing of long-term care. This will require LTC administrators to change their business practices and develop new capabilities that currently don't exist in most nursing homes.

In order to develop a competitive edge, nursing homes need to think about strategic alliances with other providers in the community with complementary skills and service capabilities. Organized appropriately, such alliances are more efficient than one facility trying to develop all those capabilities on its own. The following steps will help ensure that facilities achieve their business goals in participating in an alliance.

1) Broaden your vision. It is important to perceive your business as extending beyond the walls of your institution. Services should relate to the care of people with chronic diseases and disabilities throughout their natural progression.

2) Assess existing alliances. Assess the natural alliances you already have - primary referral relationships, providers who share your values, those with complementary skills and services. These are the natural vehicles for beginning partnerships.

3) Rethink your business. Know your cost (not just your charges), become able to manage care across settings, institute disability prevention strategies. Retool your business skills for tomorrow's business needs.

4) Build new relationships. Explore alliances with other LTC, providers in your market area. Reach out to physician groups, hospitals and community organizations that strengthen your market position. Explore new collaborative business opportunities.

5) Take charge, Develop new leadership capabilities, establish new governance arrangements, new methods for collecting and using data across settings, new structures of shared risk financing and financial management, and new collaborative approaches to care. Build skills and relationships that position you to thrive in the health care environment of tomorrow. Move forward - and don't look back.

Barbara Vaughan is Director of Communications and Operations for the National Chronic Care Consortium, Bloomington, MN. For more information, call 612-858-8999 or visit the new NCCC Web site at www.ncccresourcecenter.org