Network Spotlight: Community Care Alliance

December 2016
Community Care Alliance

Community Care Alliance board members participate in a recent retreat in Grand Junction, Colorado. The slide displays a quote attributed to Yogi Berra: "If you don't know where you're going, you'll end up someplace else."

Network Name Community Care Alliance
Location Grand Junction, CO
Key Contacts Angelina Salazar, Vice President of Outreach and Communications for Western Healthcare Alliance, and Marnell Bradfield, Director of Operations for Community Care Alliance
Mission The Community Care Alliance prepares healthcare organizations for success in the future, where medical communities will be rewarded for achieving better care, healthier people, and smarter spending.

The Community Care Alliance (CCA) will develop a centralized and efficient infrastructure consisting of IT and analytics, practice transformation support, training and best practice guidance, quality monitoring and reporting, care coordination models, health and benefits programs, and management services to meet the varying needs of its members and their clinically integrated networks (CINs). CCA will seek active partnerships with other rural networks throughout the nation, in order to increase economies of scale and bolster the primary goal of providing cost effective population health management solutions for member-owners.

Angelina Salazar and Marnell Bradfield were interviewed by NCHN’s director of member services to share information on the network’s characteristics, key learnings, accomplishments, and challenges.

Q: In a “nutshell,” how would you describe your network?

A: Western Healthcare Alliance (WHA) is a member-owned network. Community Care Alliance (CCA) is an LLC owned by WHA, founded to create solutions for rural health care. All of the WHA members conversed, recognizing the value of small rural organizations and needing to do something to be prepared for value-based reimbursement. From those conversations, CCA was formed. The purpose was to explore all opportunities to help prepare organizations for value-based reimbursement and the changing health care landscape. 

CCA started in March 2015 and has its own board. The board discussed the best way to support the organizations.  It recognized the best way to do that was Track 1 Performance-Based Medicare Shared Savings Program ACO [Accountable Care Organization]. Right now, CCA is providing management services for two Medicare Shared Savings Program ACOs. We’re providing the tools and support to be successful, thereby assisting them to be ready to move into Medicare Access & CHIP Reauthorization (MACRA) and Merit-Based Incentive Payment System (MIPS). Additionally, we’ve been awarded the recognition as a practice transformation organization by the Colorado Practice Transformation Network, which is a TCPi participating network.  

Q: What has been key to your network's success thus far?

A: Being part of WHA, and the fact that it’s member owned and those members recognize a need for CCA and a need for ACO support, we have lots of buy-in. We have enormous support from hospitals to the practices in their communities. Whether they provide people to augment the practice or financial assistance, the hospitals’ commitment to make sure these practices are successful is amazing. Hospitals are helping to support infrastructure of CCA.

It’s rare to find a group of CEOs who are willing to take the time these hospital CEOs take and put so much thought into the sustainability of health care in their communities. The CEOs have a history of competition and now are willing to collaborate. They see the benefits of collaboration over competition, and the one who wins is the patient. This group tries to make changes and take ownership.

Q: What are some of the advantages and disadvantages of working in your unique rural area?

A: Our biggest difficulty is also our biggest asset: we’re small and rural and separated by geography. The organizations vary in size. This makes it hard to develop programs and services to meet needs of that variety. The asset is we’re collectively a little smaller, so we can create rapid cycles of change and be very fluid and react quickly. It’s an asset, but we have to be creative with programs we’re writing. We can’t put everyone in the same box.

Being involved in an ACO environment is also challenging, dealing with lots of different organizations and personalities. You have to find middle ground. Everything is new. The whole concept of ACOs is new. We are inventing the wheel with innovative models on lots of things, which gives us energy to come to work.

One of our key objectives in year one is that every participant has a care coordination model. Recognizing we’re many different types of organizations, we can’t come in and dictate a certain discipline for the care coordination. In a solo practice, the best coordinator may be a high functioning practitioner. Somewhere else, it may be a Licensed Clinical Social Worker.  In order to honor the culture of the practice and the community, we need to embrace all the disciplines, which presents challenges for education.

Being rural, we inherently know practices are already doing a great job of care coordination, but it’s informal. We capitalize on relationships providers already have. We know it’s being done; now we’re working on formalizing ways to demonstrate their efficacy. In really small areas, people want to take care of each other. In rural health care settings, it’s easier to provide whole care, because you know the individual outside the medical office.

Q: What are your main tasks for the coming year?

A: One requirement of an ACO by CMS is to report on quality measures. For the Group Practice Reporting Option (GPRO), having successful submission is key. We will report on 2016 in the first quarter of 2017. Additionally, we are focused on qualifying for shared savings, focusing on care coordination for the top 10% of highest cost, highest-utilizing patients. We will try to expand that capability to rising-risk patients, trying to make impacts before cost is a bigger issue. We are really continuing to build the foundation for them being ready for MIPS.

Q: Based on your experiences, what advice do you have for a developing rural health network?

A: Like the leadership guru Simon Sinek has said in his lectures, don’t forget the “why.” We are constantly in a reactionary state, leading to burnout. Always remember why you’re doing what you’re doing. Don’t forget who you are and how it all began. The mission of CCA is the center of everything we are doing. It is about the patient.

Also, be flexible. Oftentimes when you’re dedicated to your role, you can become too attached to your work. In this landscape, own your work, but own it “loosely” so when it’s removed from you, you can easily take on the new challenge in front of you. Health care is always an adventure.


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