Difficult, but Rewarding Work of Public-Private Partnerships to Address Health Issues

A public-private partnership in Northern Nevada is combining genotypic, phenotypic, and environmental data to improve population health for an area that had poor health outcomes. In a presentation and panel discussion at the ACO & Emerging Healthcare Delivery Coalition^®, held May 4-5 in Scottsdale, Arizona, attendees learned about successful public-private partnerships that are improving population health and the challenges of setting up and implementing these partnerships.

Anthony Slonim, MD, DrPH, president and CEO of Renown Health and chair of the Coalition, moderated the panel discussion, which included 2 speakers from Renown. In September 2016, Renown implemented a unique partnership with the state’s Desert Research Institute and DNA testing company 23andMe.

Within 48 hours of opening enrollment, 10,000 people had signed on to have their genetic information collected at no cost as part of this initiative, .

The area where Renown and DRI were located was perfect to implement a population health and genetic study, explained Joe Grzymski, PhD, senior director of the Applied Innovation Center at DRI. Nevada is a mostly empty state and in Northern Nevada, Renown is the only tertiary facility in 11 counties. The area that Renown covers is equivalent to New York, New Jersey, and Pennsylvania.

In addition, this area has very poor health outcomes with significant instances of malignant cancers, such as pancreatic and liver cancer, and a high age-adjusted death rate for cardiovascular disease.

“It was the ultimate strategic planning process,” explained Slonim. For example, with higher rates of cancer in the area, Renown could tell if it might need more surgeons in 5 years to care for the population.

More than that, though, the participants are getting something back, Grzymski said, because they are receiving the results and being engaged with to modify their behaviors as a result of what the test finds.

The next step in the initiative is to expand to 100,000 people in 5 years and add a genetic counseling focus.

“This is something that we hope will end up going back into the community through investments in everything from rural access to care to new R&D given our own specific problems,” Grzymski said.

He then joined a panel discussion with his colleague Christos Galanopoulos, MD, MBA, MSc, FACS, vice president and medical director for the Renown Institute for Cancer; Ross Owen, health strategy director at Hennepin County, Minnesota; and Susan Mathieu, program manager for the Accountable Care Collaborative at Colorado Department of Health Care Policy and Financing.

Owen explained that when they began work in Hennepin to provide care for people added under the state’s Medicaid expansion, they focused on extreme outlier cases because they were a good place to start the conversation about where the best return on investment was.

Hennepin Health was created as a partnership between the local government and Hennepin Medical Center to provide care to the people newly insured under Medicaid expansion.

When building these partnerships, a solid understanding of what both sides get out of it and what they each hope to accomplish is critical.

“You have to really have a foundation of trust,” Mathieu said. “We have to, at the public level, really believe that our private partners are trying to do the right thing.” They may have a board of directors to report to or shareholders, but they ultimately care about what they do, she added. And the same is true in the other direction: the private partners have to believe the public workers are not just in it to collect a paycheck while they wait to retire.

When there are opportunities for a partnership, having the right people at the table makes all the difference, Galanopoulos explained. He never would have thought the partnership with 23andMe could have happened before Slonim joined Renown and the initiative wouldn’t have been successful without the environmental research expertise of Grzymski.

Even if they make mistakes and fail at some steps along the way, having the right team is important to keep moving forward, he said. Slonim agreed.

“You can’t be so risk adverse that you’re not willing to fail,” he said.

While these partnerships have so far been successful, all the panelists acknowledge how difficult it can be. Grzymski recommended that organizations play to their strengths and not get distracted by going “after the shiny object.”

Owen added that while the venture is worthwhile, they didn’t expect how difficult it would be to keep the ball rolling.

“It’s shoveling coal sometimes,” he said.

Finally, Mathieu recommended that to combat how difficult this work can be, the scope of the work can be made more manageable by targeting specific areas and communities. If one region or community is able to address emergency room visits, that success might then be replicated elsewhere.

“But we cannot necessarily think for 6 million people across the state all at one time,” she said. “So I think being mindful of that has been helpful.”