Alliance for Health limits CON review
Focus will only be on projects exceeding $10 million.
In light of newly added initiatives and strategic focus, Grand Rapids-based health care coalition Alliance for Health has announced a major change in its involvement with the Certificate of Need process.
The AFH announced Feb. 5 the CON Evaluation Board, an independent body overseeing the Certificate of Need review process for the broad-based community coalition, will limit its review of CON applications to health care projects exceeding $10 million that propose a new major service in the region, consolidation of existing health care organizations, or change in ownership.
In a letter to AFH stakeholders, president and chief executive officer Paul Brand stated the agency is “narrowing the focus on CON review and broadening the scope of public discussion concerning health care projects of community interest.”
“Under this new review process, the Alliance for Health would have reviewed less than eight new projects per year in the last three years, a savings of our resources for an unreimbursed responsibility going forward,” said Brand in the press release.
The Alliance for Health became involved in the CON review process in 1972 as a way to reduce duplications of health care services in an effort to keep costs low while improving quality of care.
In 2012, the organization evaluated more than 30 projects with expenditures totaling roughly $224 million, according to its annual report.
Despite the change in criteria, the AFH will maintain its statutory obligations as the CON regional review agency for West Michigan under the Michigan Public Health code, according to the press release.
Following the recent addition to the Alliance’s services of a small-employer health benefit maximizer plan and a health-risk management program for self-funded employers, the Evaluation Board compiled a report to determine the organization’s continued participation in the review process. During the comprehensive review, the Evaluation Board interviewed approximately 45 community stakeholders in determining the changes of the application process.
Carl Ver Beek, attorney at Varnum and a community stakeholder interviewed during the process, said although not directly affiliated with the Alliance, he is familiar with the organization due to the number of health-related boards on which he serves.
In reference to the limitation on the CON process, Ver Beek said it is a good way for the Alliance to continue to perform an important function for West Michigan in a manner that is consistent with its resources.
“I think it is probably a good position for both the community and the Alliance to have this somewhat limited role in the CON process,” said Ver Beek.
“The Alliance is reinventing itself and probably couldn’t continue its full-blown role as it had in the past, but this allows it to keep the momentum it had developed in a positive way in this area.”
With the change in guidelines, it also opens up the opportunity for any member of the Alliance for Health to request a review by the agency of a particular project not meeting the new criteria that may impact quality, access and cost of health care services in the region.
Brand indicated in the letter to stakeholders the Alliance is also “advancing on the new opportunity afforded under the state of Michigan’s ‘State Innovation Model’” to be selected as a SIM Pilot for the Community Health Innovation Region, which includes a 13-county region in West Michigan.
The Centers for Medicare and Medicaid Services created the SIM initiative to provide financial and technical support to states developing and testing a state-led, multi-payer health care payment and service delivery model. The intended model would improve health system performance and quality of care while reducing the costs for beneficiaries of Medicare, Medicaid and Children’s Health Insurance Program.
“The Michigan Department of Community Health has received federal funding from the Center for Medicare Services to develop new payment and service delivery models,” stated Brand in the letter. “To us, this seems a natural progression of the traditional role of the Alliance for Health, and we are pursuing the opportunity to ensure we are selected.”
The Alliance for Health is in the process of a multi-stakeholder study to gain support for West Michigan to become a community health improvement model, according to the letter.