Partnerships between UC Davis Health and community hospitals help both — and the region — during a time of seismic change in health care.
In an emergency room in the Sierra Foothills town of Placerville, fellowship-trained UC Davis Health vascular neurologists work hand-in-hand with local care teams to provide aggressive on-site treatment for acute strokes.
Head an hour eastward over the Sierra crest, and you’ll find UC Davis infectious disease specialists assisting a small South Lake Tahoe hospital with new statewide standards for improving antibiotic use.
Down the hill, a team of UC Davis physicians provides the brunt of daily on-site hospitalist care for inpatients at a 190-bed community medical center. And five hours south on State Route 99, university oncologists are helping to bring on-site cancer treatment to an isolated critical-access hospital in the northern Mojave Desert.
These efforts and several others are among a growing series of partnerships and affiliations between UC Davis Health and community hospitals throughout inland Northern and Central California. The arrangements, which can include both clinical and operational elements, are designed to blend academic expertise and local knowledge to benefit both partners and the communities they serve.
“Hospitals large and small are working hard to navigate the shifting health care landscape and ensure the best care for our patients — and at UC Davis Health part of our strategic plan is to continue strengthening our collaborations with other providers,” said Maureen McKennan, a nurse practitioner and attorney who has served as UC Davis Health’s regional affiliations officer since 2013 (see Q&A). “We’re really focused on finding new and innovative ways to work together, especially with providers who are interested in pursuing community-wide and population health solutions with us.”
Partnerships have long been a mechanism of the Sacramento-based academic health system’s “outreach” mission, intended to help share insights from its research, clinical care and teaching missions across the greater region and beyond. But in the reform era, collaborations are becoming increasingly important as more pragmatic mechanisms of stability and sustainability as well — ways to adapt in the nation’s swing toward value-based care, population health management, meaningful use of electronic medical records and other institutionalized cost-benefit strategies.
Even with recent shifts in political winds and seemingly daily levels of “what today?” unpredictability about specific elements of reform or reimbursement, McKennan said the overall jetstream still flows toward partnership.
“Generally, the path going forward will focus on driving down costs with reforms of payment systems and care delivery systems — and no matter what the current politics, value-based payments that reward quality and better outcomes are likely here to stay,” she said. “Strategic affiliations are going to be advantageous — and frankly, often necessary — in this new environment.”
Affiliations are still a theme in forward-looking analyses from health care professional organizations, academicians, consultancies and media. While some health systems are moving toward acquisitions and mergers, McKennan said UC Davis’ current focus is aligning and collaborating with community partners instead.
That approach that allows partners to remain independent if desired, she said, while still providing opportunities for meaningful collaboration and cost savings through increases in scale, enhanced continuity of care and other mechanisms. Partnerships also tend to be nimbler and avoid the significant investment and integration challenges of mergers.
Even limited-scale affiliations create valuable new relationships that can serve as a strong base from which to explore future opportunities and challenges together, added Khanh-Nhat Tran-Viet, M.H.A., a regional affiliations and outreach manager who works closely with McKennan and helps to support the UC Davis Health Cancer Care Network.
“We’re not an institution that’s looking to ‘overrun’ community providers, and a big part of that is our role and tradition as a public institution with strong research and education missions,” he said. “Our approach is that we have a wide range of services available, and if something that we can offer supplements or complements your own services to help you care for patients in your own community, we’re glad to offer it.”
On the clinical side, many partnerships are designed to allow community hospitals to keep and treat more patients locally, without the ongoing challenge of recruiting and retaining expensive subspecialty expertise in a rural locale. Patients stay near their homes and emotional support networks while receiving care infused with academic insight as needed. Meanwhile, UC Davis preserves crucial capacity at its medical center — the main tertiary and quaternary care facility for a 33-county region — for the more severe cases that it’s uniquely suited to address.
Both academic and community partners can also stand to benefit from potential boosts in continuity of care. Increased knowledge of UC Davis systems generally creates more predictability for community hospitals when transfers to UC Davis Medical Center are needed, and in turn the university relies on the enhanced local knowledge of its community partners to help create smoother post-acute landings with less potential for readmissions.
And for population health purposes, on-the-ground local knowledge can also help to complement academia’s abilities to harness and crunch big data.
“We’re a remote and rural community, and in some ways a better place than an urban area to work on population health management,” said James Suver, M.H.A., CEO of Ridgecrest Regional Hospital, the Mojave-area facility that’s working with UC Davis on cancer care and antimicrobial stewardship. “We’re also a member of the national rural accountable care organization and going down that road about how to provide higher-quality care at a reasonable cost.
“I think we’re a contained-enough microcosm that if there are ideas that need to be explored, we’re a perfect community to do that. And I’m hoping that we can reciprocate in our relationship with UC Davis by sharing some of the things we’ve been successful with in that aspect.”