Triton Group, LLC.Lebow, Malecki & Tasch, LLC.1 BUILDING A BETTER ORGANIZATION BY COLLABORATING WITH OTHER BUSINESS PARTNERS: RISKS AND BENEFITS Martin

Triton Group, LLC. Lebow, Malecki & Tasch, LLC. 1

BUILDING A BETTER ORGANIZATION BY COLLABORATING WITH OTHER

BUSINESS PARTNERS:RISKS AND BENEFITS

BUILDING A BETTER ORGANIZATION BY COLLABORATING WITH OTHER

BUSINESS PARTNERS:RISKS AND BENEFITS

Martin J. Bree, MBA, MHA, JDMelinda Malecki, JD, MS

March 28, 2008

Martin J. Bree, MBA, MHA, JDMelinda Malecki, JD, MS

March 28, 2008


Organizational Collaboration:

A process in which organizations exchange information, alter activities, share

resources, and enhance each other’s capacity for mutual benefit and a common purpose by sharing risks, responsibilities

and rewards. (Arthur Himmelman).

Organizational Collaboration:

A process in which organizations exchange information, alter activities, share

resources, and enhance each other’s capacity for mutual benefit and a common purpose by sharing risks, responsibilities

and rewards. (Arthur Himmelman).


The difference between collaborating and cooperating is the willingness of

organizations to enhance each other’s capacity for mutual benefit

and a common purpose. (Himmelman).

The difference between collaborating and cooperating is the willingness of

organizations to enhance each other’s capacity for mutual benefit

and a common purpose. (Himmelman).


Why this is an emerging trend for community health centers:

Need for more Primary Care Services Desire to conserve resources Providers see the value of the CHC’s

skills and resources CHC’s can FURTHER carry out their mission of

providing community health care

Why this is an emerging trend for community health centers:

Need for more Primary Care Services Desire to conserve resources Providers see the value of the CHC’s

skills and resources CHC’s can FURTHER carry out their mission of

providing community health care


Examples of Types of Collaborative Relationships

Examples of Types of Collaborative Relationships


1. CHC contracts with Hospital to operate primary care clinic(s) on hospital campus or inside the Hospital. CHC is given complete control of the operation. It is a “site” of the CHC.

1. CHC contracts with Hospital to operate primary care clinic(s) on hospital campus or inside the Hospital. CHC is given complete control of the operation. It is a “site” of the CHC.


Documentation: Collaborative Agreement

Grant and Support Agreement

Lease (fair market value)

For FTCA protection prior approval from BPHC in form of an approved change in scope application is required


Grant and Support Agreement

Lease (fair market value)

For FTCA protection prior approval from BPHC in form of an approved change in scope application is required


2. CHC contracts with Hospital to operate the Hospital-owned clinic on the Hospital’s campus.

2. CHC contracts with Hospital to operate the Hospital-owned clinic on the Hospital’s campus.


Documentation: Management and Services Agreement

For FTCA protection prior approval from BPHC in form of an approved change in scope application is required.

Documentation: Management and Services Agreement



3. CHC joint ventures with Hospital for ambulatory care facility off Hospital’s campus

3. CHC joint ventures with Hospital for ambulatory care facility off Hospital’s campus



Management Agreement

Services Agreement

FTCA coverage not clear, depends on employment relationships of staff with deemed entity. At a minimum. prior approval from BPHC in form of an approved change in scope application is required. FTCA technical assistance recommended.


Management Agreement

Services Agreement

FTCA coverage not clear, depends on employment relationships of staff with deemed entity. At a minimum. prior approval from BPHC in form of an approved change in scope application is required. FTCA technical assistance recommended.


4. CHC contracts with local health department to operate one of the health department’s clinics.

4. CHC contracts with local health department to operate one of the health department’s clinics.


Documentation: Service(s) Agreement

For FTCA protection prior approval from BPHC in form of an approved change in scope application is required. Health Department employees not protected. FTCA technical assistance recommended.

Documentation: Service(s) Agreement

For FTCA protection prior approval from BPHC in form of an approved change in scope application is required. Health Department employees not protected. FTCA technical assistance recommended.


5. CHC rents space in local health department and operates health center site inside health department facility.

5. CHC rents space in local health department and operates health center site inside health department facility.


Documentation: Lease (FMV) Service Agreement

For FTCA protection prior approval from BPHC in form of an approved change in scope application is required. FTCA technical assistance recommended.

Documentation: Lease (FMV) Service Agreement



6. CHC sub-grants to local health department. Local health department operates a health center as a subgrantee.

6. CHC sub-grants to local health department. Local health department operates a health center as a subgrantee.


Documentation: Grant and Support Agreement

Notice of Grant Award that authorizes the subgrant. CHC functioning as a grantor but still responsible for HRSA.

Separate deeming application for the grantee and subgrantee required for FTCA coverage. FTCA technical assistance recommended.

Documentation: Grant and Support Agreement

Notice of Grant Award that authorizes the subgrant. CHC functioning as a grantor but still responsible for HRSA.

Separate deeming application for the grantee and subgrantee required for FTCA coverage. FTCA technical assistance recommended.


7. CHC contracts with local health department to provide staff to health department clinic.

7. CHC contracts with local health department to provide staff to health department clinic.


Documentation: Management / Staffing Agreement

This needs to be within scope to have potential FTCA coverage—may need gap coverage. FTCA technical assistance recommended.

Documentation: Management / Staffing Agreement

This needs to be within scope to have potential FTCA coverage—may need gap coverage. FTCA technical assistance recommended.


8. CHC contracts with teaching institution to operate a medical residency program where CHC employs residents and educates them about primary care and/or community medicine

8. CHC contracts with teaching institution to operate a medical residency program where CHC employs residents and educates them about primary care and/or community medicine


Documentation: Employment Agreement (Residency Agreements should be proposed by academic center)

FTCA may not cover all activities of the residents. HRSA has limited FTCA coverage.

Documentation: Employment Agreement (Residency Agreements should be proposed by academic center)

FTCA may not cover all activities of the residents. HRSA has limited FTCA coverage.


9. CHC “A” contracts with CHC “B” to take B’s third trimester OB patients because B no longer provides deliveries. A sends its staff to B to see the patients in the third trimester.

9. CHC “A” contracts with CHC “B” to take B’s third trimester OB patients because B no longer provides deliveries. A sends its staff to B to see the patients in the third trimester.


Documentation: Services Agreement?

FTCA coverage can be a problem when A’s staff are at center B. FTCA technical assistance highly recommended.

Documentation: Services Agreement?

FTCA coverage can be a problem when A’s staff are at center B. FTCA technical assistance highly recommended.


10. CHCs “A” and “B” desire to share staff. 10. CHCs “A” and “B” desire to share staff.


Documentation: Staff Sharing Agreement

Overhead Sharing Agreement

Management Agreement if one employs all of them and “leases “back” to the

other

FTCA coverage can be a problem when staff staff are leased. FTCA technical assistance recommended.

Documentation: Staff Sharing Agreement

Overhead Sharing Agreement

Management Agreement if one employs all of them and “leases “back” to the

other

FTCA coverage can be a problem when staff staff are leased. FTCA technical assistance recommended.


11. CHC contracts with school district in remote community to provide emergency coverage in schools.

11. CHC contracts with school district in remote community to provide emergency coverage in schools.


Documentation: Service Agreement to Provide Emergency Coverage

Will you call 911? Consider an Emergency Transfer Agreement

FTCA coverage can be a problem. Are these students considered health center patients? A particularized determination may be required. Technical Assistance highly recommended.

Documentation: Service Agreement to Provide Emergency Coverage

Will you call 911? Consider an Emergency Transfer Agreement

FTCA coverage can be a problem. Are these students considered health center patients? A particularized determination may be required. Technical Assistance highly recommended.


12. CHC contracts with local government to operate primary care facility in correctional institution.

12. CHC contracts with local government to operate primary care facility in correctional institution.


Documentation: Services Agreement





13. CHC contracts with nursing home to provide primary care to all nursing home residents. (Not medical director)

13. CHC contracts with nursing home to provide primary care to all nursing home residents. (Not medical director)







14. CHC contracts with V.A. Hospital to see V.A. patients at the CHC. (Not medical director)

14. CHC contracts with V.A. Hospital to see V.A. patients at the CHC. (Not medical director)



No FTCA issues so long as veterans are seen at the health center and provided services in the approved scope of project.


No FTCA issues so long as veterans are seen at the health center and provided services in the approved scope of project.


In any contractual arrangement consider at least:

1. Term2. Termination without cause provision3. Compensation4. Confidentiality Agreements5. Restrictive Covenants6. Indemnity Provisions7. Ask if they have a standard agreement

In any contractual arrangement consider at least:

1. Term2. Termination without cause provision3. Compensation4. Confidentiality Agreements5. Restrictive Covenants6. Indemnity Provisions7. Ask if they have a standard agreement


Example of Integrated Behavioral Health Collaborative Relationship between CHC and two other parties:

Example of Integrated Behavioral Health Collaborative Relationship between CHC and two other parties:


Background

1. Research indicates individuals are more likely to access mental health treatment through primary care providers

2. Integrated model presents an opportunity for increased access to care and enhanced clinical outcomes

3. Three main components of the collaboration: primary care, parenting support program and community outreach

4. Parties: CHC, Mental Health Center, School of Professional Psychology

Background

1. Research indicates individuals are more likely to access mental health treatment through primary care providers

2. Integrated model presents an opportunity for increased access to care and enhanced clinical outcomes

3. Three main components of the collaboration: primary care, parenting support program and community outreach

4. Parties: CHC, Mental Health Center, School of Professional Psychology


Purpose

To provide clinically integrated services focused on the prevention, reduction or treatment of social or emotional dysfunction or stress that has a negative impact on the health or quality of life by the individual or family served.

Purpose

To provide clinically integrated services focused on the prevention, reduction or treatment of social or emotional dysfunction or stress that has a negative impact on the health or quality of life by the individual or family served.


Principles of Collaboration:

- broader access to health and mental/behavioral health care

- improved communication among healthcare providers leading to better care coordination and few clinical errors

- enhanced patient and family satisfaction- opportunities for mutual teaching and learning

across healthcare disciplines- improved patient/consumer health/mental health

status and clinical outcomes

Principles of Collaboration:

- broader access to health and mental/behavioral health care

- improved communication among healthcare providers leading to better care coordination and few clinical errors

- enhanced patient and family satisfaction- opportunities for mutual teaching and learning

across healthcare disciplines- improved patient/consumer health/mental health

status and clinical outcomes


“In this partnership we are building on our historical commitment to mental and emotional wellness of children, youth and parents by offering an array of services that includes counseling, educational presentations. . .for youth. Now, in partnership with CHC, we can ensure that children and parents from a variety of communities will have access to these essential behavior healthcare services.” President and CEO of Mental Health Center

“In this partnership we are building on our historical commitment to mental and emotional wellness of children, youth and parents by offering an array of services that includes counseling, educational presentations. . .for youth. Now, in partnership with CHC, we can ensure that children and parents from a variety of communities will have access to these essential behavior healthcare services.” President and CEO of Mental Health Center


How is this operationalized?How is this operationalized?


Example of a Result of this Collaboration (2007)

20% of adolescents engaged in ongoing counseling for an identified risk

Example of a Result of this Collaboration (2007)

20% of adolescents engaged in ongoing counseling for an identified risk


Legal relationship: Service Agreements between CHC and the Mental Health Center and CHC and the Academic Program

Legal relationship: Service Agreements between CHC and the Mental Health Center and CHC and the Academic Program


The Collaboration Process very brieflyThe Collaboration Process very briefly


Identify Potential Partner

Hedgehog Theory

Identify Potential Partner

Hedgehog Theory


Build a Win/Win Strategy Build a Win/Win Strategy


Consider implications for FTCA coverage

Consider implications for FTCA coverage


Legal Structuring / documentation of the relationship

– To memorialize the relationship – To protect rights of CHC– To ensure compliance with laws

Legal Structuring / documentation of the relationship

– To memorialize the relationship – To protect rights of CHC– To ensure compliance with laws


Risk Management Implications

– All parties carry own insurance– Other parties indemnify CHC

Risk Management Implications

– All parties carry own insurance– Other parties indemnify CHC


Quality Implications

– CHC monitors quality data from collaboration as part of its Quality Management Program

Quality Implications

– CHC monitors quality data from collaboration as part of its Quality Management Program


Further reading

Collins, Jim, Good to Great

Himmelman, Arthur T. Collaboration for a change, Definitions, Decision-making models, Roles and Collaboration Process Guide. [email protected].

Further reading

Collins, Jim, Good to Great

Himmelman, Arthur T. Collaboration for a change, Definitions, Decision-making models, Roles and Collaboration Process Guide. [email protected].

Documents

Triton Group, LLC.Lebow, Malecki & Tasch, LLC.1 BUILDING A BETTER ORGANIZATION BY COLLABORATING WITH OTHER BUSINESS PARTNERS: RISKS AND BENEFITS Martin