Client Profile: Three Michigan hospitals in close proximity to one another

Project Type: Collaborative arrangement facilitation

Challenge: To determine if three competing hospitals could form a local health system through the formation of a joint operating agreement, merger, or some other structural arrangement

ACCORD's Solution and Results: ACCORD was retained by the three hospitals to serve as a neutral facilitator of the deliberations of the three boards and CEOs. We structured the discussion process, including the formation of a Task Force consisting of the CEOs and board leaders from each organization; conducted individual interviews with the Task Force members to gauge the feasibility of the undertaking; reviewed relevant documents; provided advice on communications; and educated the Task Force members on the range of options available to the three hospitals. ACCORD also recommended retaining DGA Partners to conduct a "base case" study to determine the likely financial impact if the parties were to not come together in some arrangement.

ACCORD consultants facilitated several meetings of the Task Force to explore all of the above information and reached the conclusion that a merger was the most desirable collaborative model, in terms of meeting the healthcare needs of the community and ensuring financial stability for the three organizations. Unknown at the time, one of the three hospitals violated its agreement to not discuss opportunities with other providers in the region and, at the last minute, pulled out of the discussions with the other two hospitals. The remaining two hospitals moved forward with immediate plans for integration of clinical services and other collaborative efforts, but determined that a full merger no longer was the optimal arrangement for them.

Client Profile: A 14 hospital health system with over 100 outpatient sites

Project Type: Physician alignment planning facilitation

Challenge: To facilitate a 3-way planning process among two large, competing cardiology groups and the health system, with the goal of developing a contractual relationship that would benefit all three parties

ACCORD'S solution and results: Over the course of one year, ACCORD designed and facilitated a number of planning sessions among the leadership representing the three parties. Since the parties were not interested in developing a joint venture, we educated the participants on the types of arrangements available to them and the psycho-social dimensions that could make or break the deal the parties were attempting to put together. Due to events outside the control of the parties, discussions were put in abeyance for almost one year.

After the hiatus, ACCORD was reengaged to resume the planning process. This time, the leadership of the cardiology groups worked with us on a parallel path to discuss the possibility of a merger of the two groups. After the cardiology groups agreed to merge, the negotiations with the health system accelerated and were brought to a successful conclusion.

Today, this health system is in a close, legal relationship with the premier cardiology group in its primary market. The parties have achieved gains in clinical quality and mutual financial benefits, without the burden and expense of forming a joint venture entity.

Client Profile: A large multi-hospital system in the Midwest

Project Type: Integration and business planning

Challenge: To quickly integrate physician groups as they were being acquired by the health system in order to ensure the success of the acquisitions

ACCORD'S solution and results: As the health system was implementing its strategy to employ large numbers of physician, ACCORD was retained to design and facilitate planning sessions with the acquired physician groups during and immediately following the acquisition process. We convened meetings with clinic leadership to: help them understand what the integration process would entail; develop one year business plans, including measurable goals for each clinic site; and to address some of the emotional issues that often occur after physicians have given up total control of their practices.

Over the course of several years, the health system acquired dozens of physician groups representing hundreds of physicians. The health system's multi-specialty medical group is now one of the largest in the country and is profitable and continues to win numerous quality awards.

Client Profile: An expanding 200+ bed Pennsylvania single hospital system

Project Type: Comprehensive governance assessment including structure, policies, and practices

Challenge: To assist the board in upgrading its governance function at the same time the board was experiencing intense external scrutiny over its practices

ACCORD'S solution and results: Working under extreme time pressures, ACCORD teamed up with the board and its other advisors to conduct a detailed review of the system's governance legal documents, structures, policies, practices, strategic vision, minutes of board and committee meetings, self-evaluation information, board orientation program, education plans, financial situation, and more. We interviewed all of the board members, senior executives, and physician leaders individually to understand their perspectives on the system's governance strengths, weaknesses, suggestions for improvement, and to understand the politics and culture of the organization.

After completing the assessment phase of our work, we prepared a draft set of findings, observations, and recommendations for presentation to the full board and senior executive team. During a 3-hour working session with the board, we educated the board on "best practice trends" in not-for-profit governance; reviewed the draft report; and, secured the board's feedback on the recommendations.

Based on the results of the board work session, we prepared a final report and a number of key policies and procedures for immediate implementation by the board and its committees. We also provided a list of additional policies and governance practices for implementation over a phased timeline.

The comprehensive assessment has resulted in a revised governance structure for the system, including the immediate formation of a Governance Committee to oversee the implementation of the study recommendations; a new set of critical board policies; and a number of practices to enhance how the board carries out its responsibilities. The quick action taken by ACCORD also helped to alleviate some of the external pressures that the board was experiencing.