The Boulder Valley Care Network (BVCN) may well be the only health care collaboration that can claim to have been inspired by monkeys. While visiting the Central American rainforest, Bob Jamieson, Benefits Director for Boulder Valley School District (BVSD), watched in awe as spider monkeys used each other as bridges to climb through the canopy. Witnessing their teamwork to achieve a common goal helped him envision a way to assist his employees with navigating the tumultuous waters of health care and health insurance.
At the time, health care for BVSD employees was disjointed, confusing, and expensive. Jamieson began speaking with local providers and quickly discovered that there was no forum where he could discuss issues important to the school district as a major purchaser of health care; rather, he had to discuss his concerns as a self-insured employer with each provider and hospital individually. As a result, in 2009, he requested the creation of an alliance of provider groups and hospitals to work together to provide integrated, coordinated, and effective care with the expectation that such care would ultimately lead to cost efficiencies. The local providers launched the Boulder Valley Care Network.
Nearly five years later, BVCN consists of over 700 providers from Boulder Community Hospital, Avista Adventist Hospital, Longmont United Hospital, and their associated clinics as well as Boulder Medical Center, Longmont Clinic, the Boulder Valley IPA and integrated Physician Network. BVCN serves the employees of Boulder Valley School District and Longmont United Hospital by providing education and data analytic resources to providers, forums to discuss innovations and best practices, and helps to keep patients healthy and on track with their care regimen through nurse coaching services. The collaborative has contributed to slowing the rate of average per person medical claim increases over the last three years to two percent, and has greatly improved communication among local providers.
BVCN has an oversight structure that consists of a steering committee, a medical advisory committee, and several sub-committees and workgroups who meet regularly to ensure the network goals are on track. The participating hospitals and physician groups help fund project management and communications support for BVCN, and the employers pay for clinical coaching and data analytics support.
“Our primary focus has always been improving care coordination and the quality of care for members,” explains Jennifer Dailey, project manager for BVCN.
The development of a nurse care coaching program has been a major contributing factor to the success of BVCN. “Coaches are available for members who want a more involved medical practitioner with the time to help them understand their care management plan, navigate the system, and set health goals. The coach role is pivotal to ensure patients are equipped with the knowledge and resources they need to live healthy lives outside of the walls of our medical facilities.”
Patients direct the level at which the coaches are involved, with varying intensities of engagement ranging from in-person meetings in the home to frequent telephone check-ins or periodic receipt of educational information. Nurse coaches can also serve as patient advocates, using their connections with the medical community within BVCN to help best coordinate care and get patients access to care.
As an example, a member with worsening kidney disease needed consultation from a specializing nutritionalist in order to prevent the disease from progressing to the point of requiring dialysis. At the time, partly because the reimbursement system was not set up to consider the entire spectrum of care in the progression of kidney disease together with the local providers, a kidney nutritionalist was only available if the patient was already undergoing dialysis treatments. Through a collaborative process, the coach, in partnership with the BVCN medical advisory committee, was able to negotiate access to a nephrology practice’s nutritionalist to prevent the patient from needing dialysis.
Prior to the development of BVCN, BVSD had difficulty with simple tasks like determining where to go for care, because no central local provider repository existed. They’d often go the Benefits Department requesting assistance. Now the BVCN website features an interactive provider directory that patients can use to find providers by name, location, and services to help them identify their options.
Despite dozens of advancements in improving the effectiveness of care coordination, including the development of the provider directory and the nurse care coaches, BVCN providers still struggle with communicating essential patient information to all appropriate providers. One contributing factor is that it’s not always clear who should be communicated with, as it’s not currently required for members to designate a primary care physician or a medical home. Having this key piece of information on their health insurance member card, for example, could help BVCN providers coordinate patient care by ensuring the right information gets to the right provider at the right time. Moving into 2014, BVCN hopes that a solution to identifying where information should go will be reached and all patients will consistently receive the integrated and coordinated care they envision.
For more information, visit www.mybvcn.org or contact Jennifer Dailey at 303-522-8759.