ONEIDA/COOPERSTOWN — On June 1, Bassett Healthcare Network (BHN) and Oneida Healthcare (OHC) announced their intention to pursue a partnership agreement. While both organizations will remain independent entities with their own boards of directors, they say the partnership will provide opportunities to exchange best practices, reduce operating costs, and provide better medical outcomes. There is no formal agreement at this time.

Oneida Healthcare
“For the past three years, the board of trustees of Oneida Healthcare has been considering the benefits of partnering with a larger health system,” says Gene Morreale, president and CEO of OHC. “The delivery of health care and the reimbursement system are changing, with a special emphasis on managing the population’s health cost effectively. Add to this the problems associated with practicing rural medicine: attracting and retaining qualified employees, in particular physician specialists; serving a population that is older with more chronic diseases; and servicing a large geographical area with a dispersed population.”

BHN was an early adopter of population health and accountable-care arrangements. “Bassett is nationally recognized for creating integrated systems of care that include school-based, health-care centers, and patient-centered medical homes,” continues Morreale. “The emphasis of the BHN programs is to focus on long-term patient wellness, starting with preventive, primary care. Bassett’s years of experience will help to improve OHC practices. The collaboration will also allow us to participate in Bassett’s ACO (Accountable Care Organization), a savings program promoted by Medicare. The ACO shares with Medicare any savings generated by lowering health-care costs as long as the care meets Medicare standards. OHC will also join Bassett’s Accountable Care and Quality Arrangement with Excellus and participate in Bassett–branded insurance products offered through BlueCross BlueShield on the New York Health Exchange.”

Like most health-care providers, OHC is being squeezed both by higher costs and by lower reimbursements. “In addition to the savings … [mentioned above], OHC also anticipates reducing costs through the exchange of best practices with BHN,” opines Morreale … “The health-care environment is changing rapidly, and we need to adapt … A major driver of this partnership agreement is our need to respond to the new reimbursement model that replaces fee-for-service with a values-based payment model. That means OHC has to manage our population’s health more cost-effectively while reducing the fragmentation in patient care. OHC needs to provide better access to primary care by assuring that we can attract highly qualified, primary-care providers and by expanding access to primary care within the Oneida region at the same time we improve the patient experience. Our partnership with Bassett will assist Oneida Healthcare in … [this transition] by augmenting medical services already in place. To benchmark our progress, we’ll measure the increased access to primary and specialty care, clinical outcomes, and cost reduction.”

Oneida Healthcare was launched in 1899 as a four-bed hospital. The hospital opened its first satellite facility in Camden in 1991. Today OHC serves 24 area communities in Madison and Western Oneida counties — an area with 80,000 residents — with locations in Oneida, Chittenango, Verona, and Canastota. The campus in Oneida now includes a 101-bed, acute-care hospital and a 160-bed, skilled-nursing facility, in addition to the offsite locations. OHC established a separate corporation — Oneida Health Systems, Inc. — to handle its 285,000 square feet of real estate.

OHC employs 900 people (810 full-time equivalents) of whom 185 are members of the medical staff (142 are registered nurses.) In 2015, the hospital admitted 3,280 patients, performed 650 inpatient and 3,591 ambulatory surgeries, handled 180,067 outpatient visits, and treated 25,612 people in the emergency room. Last year, OHC generated about $93 million in total revenue.

Bassett Healthcare Network
“Running a health-care system today is like trying to build an airplane at the same time you are flying it,” quips Dr. Vance Brown, president and CEO of BHN. “We’re redesigning the practice and delivery of medicine at the same time we are trying to keep up with day-to-day operations … The challenges are … [daunting]: The country is dealing with continually rising health-care costs, large numbers of uninsured and under-insured, an over-extended health-care infrastructure, an aging population, and the rapid growth of chronic diseases. This puts strains on the nation’s health-care resources, but the strain is particularly hard on rural-delivery systems.”

Brown then addresses the partnership agreement. “The agreement with OHC is a collaboration that is vital in the current environment as we try to balance the need for volume in the traditional fee-for-service world with the transition to risk-based contracting where payment is contingent upon a number of factors … Health-care reform anticipates such partnerships will improve population health through the integrated delivery of high-quality, cost-effective health care built on a strong foundation of primary and preventive care … With 101-licensed, acute-care beds, OHC would become the second-largest hospital working with the Bassett system [and] … would strengthen the network’s continuum of services to the north with its 160-bed, extended-care facility; the short-term rehab facility; and the affiliated primary- and specialty-physician practices … OHC would expand … [BHN’s] network population of patients under a high-quality/lower-cost, risk-based payment model.”

Brown stresses that the delivery of health care in partnership with OHC will be seamless. “We do not intend to replace or steer medical services away from Oneida Healthcare,” he notes, “but rather propose to augment medical services already in place. The changes taking place are largely invisible to the patient population … Bassett, as a national leader in integrated, rural-health-care delivery, has great depth of experience that may prove beneficial to OHC. Our hospital in Cooperstown is an academic medical center with opportunities for residencies … We have significant expertise in the management of physician and mid-level practices, as well as the transformation efforts required of practices in today’s environment. BHN also has significant network expertise in the management of long-term-care facilities. In addition, OHC is welcome to join our nearly two dozen, integrated-network workgroups that share best practices. The plan is to benchmark our collective success by measuring shared savings, utilization of insurance performance, expanding primary-care access, and improving clinical outcomes.”

The Mary Imogene Bassett Hospital opened in June 1922. The hospital’s director in 1929 envisioned a rural hospital dedicated to patient care, education, and research. In short, create the strengths of a university hospital in a rural setting. Today, BHN includes six hospitals with 330 beds; 33 health centers spread over 20 communities; a durable-medical-equipment facility; a home-health-care agency with multiple locations; 20 school-based health centers; and two, long-term-care, skilled-nursing and rehab facilities. The Bassett system serves eight counties in New York state across 5,600 square miles.

The foundation for the Bassett system is Bassett Medical Center in Cooperstown, which includes a 180-bed, acute-care teaching hospital that serves as a branch campus of Columbia Physicians and Surgeons. The Bassett Healthcare Network hospitals admitted 16,400 patients in 2015 and handled 841,000 clinic visits. Emergency room visits totaled 72,500, and the hospitals recorded 14,200 surgical cases.

BHN also supports a research institute that focuses on population health, health services, and clinical research. It employs 4,400 people full time, including 363 physicians, with an annual payroll in excess of $300 million. In 2015, BHN generated $625 million in net-operating revenue. 

Discussions
According to Brown, discussions to create a strategic partnership with OHC began 18 months ago. About seven months after these discussions commenced, BHN issued a joint-release with the Oneida Nation announcing the creation of side-by-side clinics. One would serve the Oneida National Health Services and the other — the Bassett Oneida Health Center — would serve as a Bassett primary-care office. Both entities would be housed in Dreamcatcher Plaza in Oneida, a short distance from OHC. The plaza also houses the Oneida Nation Enterprises administrative offices and the Nation’s culinary school. Bassett opened its center in February 2016, providing primary and orthopedic care accompanied by laboratory and X-ray services. Brown and Morreale agree that the Oneida center was discussed, but suggest the project was not a primary concern.

The principals
From 1979 until 2007, Morreale served at St. Joseph’s Hospital Health Center in Syracuse. In his final post, he was VP of corporate services. He received his bachelor’s degree in health-information management for Daemen College in Buffalo and his M.B.A. in general management from Syracuse University. Morreale was a board member of the Iroquois Nursing Home and a past chair, as well as a member, of the American College of Health Care Executives. 

Brown earned his bachelor’s degree from Stanford University and his M.D. from Yale. His multiple residencies included internal medicine, emergency medicine, and family medicine. Brown spent a decade at the Cleveland Clinic and six years as the chief medical officer of Maine, before assuming his current position at Bassett on July 1, 2014.

Brown’s goal is clear: “Our relationship with Oneida Healthcare is a new one … [W]ith time and working together, we hope to replicate many of the things that are in place with our current network, including having OHC become a formal part of our network.”

Contact Poltenson at npoltenson@cnybj.com