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Value Report


CONTENTS Message from the CEO . . . . . . . . . . . . . . . . 1 Affirmant Health Partners is a Super Clinically Integrated Network – that means we bring together thousands of physician leaders from across the state to identify and promote best practices and programs that will have an impact on reducing the cost of health care and improving the health of Michigan residents. Coming together as Affirmant gives us the opportunity to take advantage of our collective strength while still preserving the independence of our Member organizations and Chapters.

Vision A healthy Michigan at an affordable cost.

Mission We collaborate with patients, colleagues and community partners to relentlessly improve the quality and cost-effectiveness of health care.

Goals Better health and affordable cost through clinical transformation. More covered lives and shared rewards through health plan partnerships.

Why Affirmant? . . . . . . . . . . . . . . . . . . . . 2

4 Fueling the Fire for Transformation . . . . . . . . . 6 Data Analytics . . . . . . . . . . . . . . . . . . . . . 8 Clinical Transformation . . . . . . . . . . . . . . 10 Health Plan Partnerships . . . . . . . . . . . . . 12 The Future Is Bright . . . . . . . . . . . . . . . . 16 Numbers Matter . . . . . . . . . . . . . . . . . . 18 Collaboration . . . . . . . . . . . . . . . . . . . . .20 Our Member Systems . . . . . . . . . . . . . . . .22 Recognition . . . . . . . . . . . . . . . . . . . . . 28 Board and Committees . . . . . . . . . . . . . . 30 Meet the Affirmant Team . . . . . . . . . . . . . 36 Our Journey . . . . . . . . . . . . . . . . . . . . . .

• First Clinically Integrated Network in the nation to implement Epic Constellation, with integrated electronic health record and claims data on 750,000 lives attributed to our primary care physicians • Clinical transformation in post-acute care, reducing Skilled Nursing Facility days per 1,000 Medicare beneficiaries by 27% over the last two years • Medicare savings of $15.4 million in 2017—the first year of operation of our Federation ACO—with $7.7 million in earned shared savings distributed to our Members and Chapters • Execution of our first Medicare Advantage contract with Priority Health effective January 1, 2019 It is hard to believe it has been just over three years since we came together to form a Super Clinically Integrated Network, based upon relationships and trust built among our founding Members through decades of collaboration in Caymich-their captive medical malpractice insurance company. Affirmant was created to enable three essential drivers of sustainable clinical transformation and value improvement:


2018 was an extraordinary year for Affirmant Health Partners. Our accomplishments include:

1. Share data analytics and best practices 2. Contract for enough covered lives to assume financial risk for total cost of care, and 3. Create an alternative to the dominant health insurance fee-for-service model In the time since our formation in July 2015, the trends propelling our collaboration have only accelerated. The Medicare Shared Savings Program as we know it is ending, with ACOs having no alternative but to accept both up- and down-side risk. Health insurance costs, including our patients’ premiums, deductibles and copayments, continue to increase. In addition, major health insurance plan fee schedules and pay-for-performance programs are not keeping pace with medical cost inflation. These trends are producing tremendous stress—burning out providers, squeezing margins, and causing patients to forgo necessary care. Affirmant gives us the opportunity to collaborate in taking charge of our destiny, to make better decisions with our patients, bend the health care cost curve and share in the rewards, and improve the health of our patients and communities. Together, I have no doubt we will achieve a healthy Michigan at an affordable cost. I am proud to be associated with Affirmant’s health care leaders and to share with you our 2018 Value Report. “Affirmant gives us the opportunity to collaborate in taking charge of our destiny, to make better decisions with our patients, bend the health care cost curve and share in the rewards, and improve the health of our patients and communities.”

Bill Mayer, MD, MPH President and CEO



The rising cost of health care is causing health plans to shift costs to patients in the form of higher premiums, deductibles and copayments, and to providers with fee schedules declining in real dollar terms.

What this means for patients:

2 of 5

privately insured adults report it is difficult to afford deductibles.

Medical expenses cause 62% of personal bankruptcies. Among Americans with household income less than 400% of the Federal Poverty Level ($97,200 for a family of four) 40% report concerns about cost having caused them to defer or forgo care. In 2018, 58% of Americans with employer-sponsored health insurance had deductibles of more than

$1,000 per year

1 of 4


What this means for providers: Providers increasingly struggle to maintain a sustainable margin with fixed fee-for-service reimbursement from our largest payers and continuing increases in our costs. This threatens our ability to remain independent and accountable to our communities.   Physicians have lost influence over  decision-making with our patients about what is medically necessary care, who can deliver this care, where it can be delivered, what constitutes quality care and how it will be paid for. Providers are burning out trying to deliver more Relative Value Units (RVUs) to make up for shrinking margins per RVU.

privately insured adults report it is difficult to afford premium costs.

The average premium cost for employer-sponsored family coverage in 2018 is up 55% since 2007.The median US household income was $59,115 in 2018.

SOURCE: KFF Employer Benefits Survey, 2018

Working together as Affirmant Health Partners, we have the power to take charge of health care for our patients and families, improving health while controlling the total cost of care. 2

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We’ve made great progress since our incorporation in 2015. This last Epic Constellation, earning $7.7 million in shared savings, enhancing Care Management and Pharmacy programs. March

Henry Ford Health System joins


Operating Agreement signed


Federation ACO MSSP participation approved CPC+ participation approved


Federation ACO incorporated


CEO hired



Affirmant strategy approved

Post-Acute Care Workgroup launched






Federation Care Network incorporated

year was no exception. Major highlights include launching our Post-Acute Care program, and kicking off our


Medicare Advantage contract with Priority Health executed

Epic Constellation core system fully validated & launched


Post-Acute Care strategy approved


Pharmacy and Safety Subgroup launched

Epic Constellation contract signed

$7.7M in Medicare shared savings earned for Federation ACO

May Chapter Participation Agreements signed



Best Practice Learning Collaborative for Care Management launched


Employee health plan TPA & PBM collaboration launched

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The Fire Triangle is a metaphor we use to describe what we are doing together through Affirmant Health Partners. Just like we cannot light a fire without oxygen, fuel and heat working together at the same time, we cannot transform health care in a meaningful way without data analytics, clinical transformation and health plan partnerships.

In 2018 our fire really started to catch on. Affirmant Health Partners



DATA ANALY Through data analytics, we will be able to make better informed decisions for Chapters and communities.

Affirmant is the first Clinically Integrated Network in the nation to implement integrated electronic health records and claims data on 750,000 lives attributed In December 2018, Epic Constellation was approved by the Information Technology and Business Intelligence Chapters for roll-out to physicians and administrative leaders. This milestone would not have been possible many leaders and champions across our network. To bring a product like this to our providers and leaders over 40 data analytics and quality experts representing all Affirmant Chapters. Hundreds of hours of their leaders would have valid, reliable and actionable data at the point of care.



Data Analytics Patient data is analyzed to produce two unique views: • Epic Constellation Healthy Planet • Cost and Utilization Dashboard

Provider Roster Chapters provide a list of local physicians participating in Affirmant



Affirmant Health Partners

3 2

Cleaning Up Data Attributed patient records are populated with patient data from Care Everywhere and claims

Patient Attribution The provider roster is linked to patients based upon attribution to primary care providers: • PCP with greater than two visits, if less than two visits • PCP with most visits, if tie • PCP most recently visited

TICS patients, practices,

Epic Constellation, with d to our PCPs.

The Cost and Utilization Dashboard displays cost and utilization trends based on claims data for specific contracts.

(IT/BI) Committee and then launched to without the support and dedication of required months of intensive effort by time went into ensuring providers and


Epic Constellation and the Cost and Utilization Dashboard • Providers will access Epic Constellation Healthy Planet Link to view Gaps in Care and standard quality measures at the point of care • Administrative leaders will access the Cost and Utilization Dashboard to access Chapter level analytics regarding usage, leakage and cost

“Epic Constellation is a game-changer for providers.”

Healthy Planet Constellation provides real-time web access to patient clinical data.

Dr. Ken O’Neill Vice President of Clinical Integration Spectrum Health Lakeland



CLINICAL TRANS Through clinical transformation, we will be able to deliver better quality at a Clinical transformation requires engagement of patients and the care team. Affirmant has launched a number of communication and training tools to promote such engagement. These include our newsletter, video blog, monthly Management Report, annual Leadership Retreat, on-line training tool to earn CME credits, and new this year, live speaking engagements with industry leaders. In September, Affirmant partnered with Glenn Steel, former President and CEO of Geisinger Health System and Chairman of xG Health for an evening of best practice sharing.


SNF Days per 1000 Beneficiaries 1600 1400

Post-Acute Care

1200 1000

800 The Post-Acute Care initiative was launched in 2017. In 2018, 600 the strategy and plan was adopted and implementation was FY2016 FY2017 1Q2018 2Q2018 3Q2018 4Q2018 started. The Affirmant strategy is focused on building networks of skilled nursing facilities (SNFs), developing SNF clinical rounding programs and improving cost and quality patient outcomes. By focusing on these areas, we have already realized great results - the Federation ACO SNFs days per 1,000 dropped 27% from fiscal 2016 to the 4th quarter of 2018.

Chronic Disease and Care Management People with chronic conditions account for 84% of national health care spending in part due to preventable hospital admissions and ED visits. The Care Management Best Practice Learning Collaborative worked through an A3 problem solving process, resulting in program recommendations unanimously approved by the Board of Managers. A new Care Management Workgroup will lead the initiative in focus areas of team and staffing, patient eligibility, engagement, care coordination and metrics.

Pharmacy and Safety The Pharmacy program launched in the last quarter of the year with a focus on reducing preventable Adverse Drug Events and related costs. By the end of the year, the group recommended a ‘future state’ and identified priorities for 2019.


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SFORMATION lower cost to our patients. Best Practice Learning Collaborative Affirmant launched a Best Practice Leaning Collaborative process in 2018, beginning with Care Management. The catalyst for a learning collaborative was conceived in the Chapter Operations Committee to identify areas where our Chapters would benefit from identifying and rapidly adopting best practices and standard work. Affirmant would like to thank the inaugural group of Best Practice Learning Collaborative members for their expertise and dedication. To see a full list of participants, visit page 33.

A3 PROCESS The Affirmant team has adopted the A3 Problem Solving Process, originally implemented by Toyota, as our standard problem solving tool. This robust problem solving and continuous improvement approach systematically takes us through nine phases: 1. 2. 3. 4. 5.

Business Case Current State Future State Gap Analysis Hypothesis

6. 7. 8. 9.

Experiments Completion Plan Confirmed State Lessons Learned

The A3 process requires three full days of brainstorming and planning in addition to hours of work at each of the Chapters. In 2018, Affirmant used the A3 process with the Pharmacy and Safety Workgroup and the Best Practice Learning Collaborative for Care Management. 11


HEALTH PLAN PA Through our health plan partnerships we will grow our patient population and share

Our integrated contracting strategy: To reach our health plan partnership goals, we must use our combined contracting influence to align incentives across all payers and assure we are rewarded fairly for our work together in improving cost and quality of care. All Affirmant contracts deliver added value to each of our Chapters.

Our strategy is to target three key ares: 1. Medicare Advantage As of September 2018, 40 percent of Medicare beneficiaries in Michigan were enrolled in Medicare Advantage plans and the number continues to grow. Affirmant has identified these plans as a priority opportunity based upon their high utilization and expense, as well as their flexibility to steer patients through in- and out-of-network differences in patient cost-sharing. In December 2018, Affirmant executed its first Medicare Advantage contract with Priority Health beginning January 1, 2019.

2. Employee Health Plans Four Affirmant Member health systems, without health insurance subsidiaries, collaborated in 2018 to simplify processes and reduce the cost of third party administration (TPA) and pharmacy benefit management (PBM) for their employee health plans. Their collective bid process resulted in standard contracts with two TPAs (ASR/HAP and ABS/BCBS) and one PBM (Express Scripts, Inc.) with first year savings of over $5.4 million.


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PARTNERSHIPS in the value we create by more efficiently and effectively managing their care. 3. Traditional Medicare Affirmant Health Partners has over 100,000 covered lives and $1 billion in annual medical spending under traditional Medicare gain- and risk-sharing agreements. Of the 100,000 beneficiaries, 70,000 come from the Federation ACO, over 24,000 from HFHS Next Generation ACO, and over 6,000 from MidMichigan POM ACO. In addition to participation in the Federation ACO, over 300 Affirmant providers (2.7 times the statewide physician participation rate) participated in the CMS Comprehensive Primary Care Plus (CPC+) program and received an estimated $1.6 million in care coordination payments in 2018. See next page for how much we saved Medicare in our first year as the Federation ACO!



HEALTH PLAN PA The Federation ACO saved Medicare over $15 Million in its first performance year Affirmant Health Partners’ Federation ACO earned $7.7M in shared savings from the Medicare Shared of the savings earned were shared with local clinically integrated networks and physicians affiliated with the land and Sparrow Health participate in the Federation ACO. In 2018, The Federation ACO welcomed four new hospitals into our Michigan-based ACO: Bronson South (Cass City, MI) and Marlette Regional Hospital (Marlette, MI).

BY THE NUMBERS: ACOs in the United States





Shared Savings

96 (or 33%) ACOs earning shared savings

20% 14

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ACOs in Michigan

of the first year ACOs earning shared savings

ACOs (4% of ACOs in the US)


Shared Savings (23% of MSSP payments)

5 (or 47%)

ACOs earning shared savings


of the first year ACOs earning shared savings

PARTNERSHIPS Savings Program in 2017. This was the Federation ACO’s first year in the program, and 100% ACO - Bronson Healthcare, Covenant HealthCare, Henry Ford Allegiance Health, Spectrum Health LakeHaven (South Haven, MI), Scheurer Healthcare Network (Pigeon, MI), Hills and Dales General Hospital

How did we achieve success? SCALE By working together to serve approximately 70,000 Medicare beneficiaries, we qualified for the lowest possible threshold for earned shared savings—2% less than target. DATA Through our partnership with Henry Ford Health System, we analyzed and shared data monthly on the performance of each of our Chapters. COMPREHENSIVE PRIMARY CARE PLUS (CPC+) As a result of our collective efforts to promote CMS acceptance of all ACO providers who applied, we have 2.7 times the state-wide rate of providers participating in CPC+. Our 335 CPC+ providers received approximately $5.5 million in care coordination payments in 2017, enabling enhanced care coordination for approximately half of all our attributed beneficiaries. QUALITY REPORTING We received 100% of Earned Shared Savings because we earned a quality score of 100%. This was accomplished through our collaboration with Primaris and Press Ganey for quality data gathering and submission. AWARENESS Our collective work at the Chapter and Affirmant levels to communicate with and engage our providers has raised awareness of the importance of improving total cost and quality of patient care and the opportunity to receive shared savings. CHAPTER MOMENTUM The work of our Chapters to improve cost and quality of care began prior to 2017 and continued throughout the year. Their initiatives built momentum for improving performance. 15


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Data Analytics Rolling out Epic Constellation and promoting its use to all our providers and Chapter leaders


2019 is off to a great start. We look forward to stoking the fire with our continued focus on all sides of the Fire Triangle.

Clinical Transformation Engaging our stakeholders in advancing clinical transformation in Post-Acute Care, Chronic Disease Care Management and Pharmacy

Health Plan Partnerships Expanding the number and percent of our patients under aligned health plan contracts for Medicare Advantage and commercial products that enable us to bend the cost curve and share in the rewards; align gain- and risk-sharing agreements with Member health system employee health plans; and explore opportunities for enhancing our risk/ reward relationship with traditional Medicare through the new Pathway to Success program

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25 Percent

of Michigan’s discharges serving 49 counties





of Lower Michigan counties served

5.5 Million Dollars


received for carecoordination through CPC+ program


attributed lives



7.7 Million Dollars

in shared savings revenue from the Medicare Shared Savings Program in 2017 18

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In 2018, Affirmant Health Partners brought Constellation, Epic’s population health tool, to our network.


Affirmant’s Epic Constellation houses:

Million Dollars

the Federation ACO saved Medicare in 2017


10.5 Million

Medical Claims

46 Million

Pharmacy Claims

3 ACOs

with over 100,000+ Medicare Beneficiaries

Records from Care Everywhere

To validate the system, a group of superstars collaborated to launch Epic Constellation:





Health Systems

and suggestions proposed

Chapter Representatives

87 Office Hours



What is a Clinically Integrated Network? Affirmant Health Partners is a Super Clinically Integrated Network (SCIN). We are connecting Local Clinically Integrated Networks (LCIN) with one another and with value-added, shared services and support—we are a network of networks. Six leading health systems and their affiliated physicians make Affirmant one of the largest Super Clinically Integrated Networks in the state of Michigan. These leading health systems are: Bronson Healthcare, Covenant HealthCare, Henry Ford Health System, Spectrum Health Lakeland, MidMichigan Health and Sparrow Health System. Our journey began in July 2015 when our network committed to partnering as a Clinically Integrated Network according to the rules of the US Federal Trade Commission (FTC). Chapter Participation Agreements and Physician Participation Agreements allow Affirmant single signature authority on contracts bringing added value to each of our Chapters.

FTC Requirements for Clinical Integration: • A network of physicians willing to demonstrate a high degree of interdependence and cooperation • A program of initiatives to control costs and ensure quality • An infrastructure that allows physicians to evaluate and modify practice patterns


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LEADERS AND LEARNERS We are a network of “leaders and learners.” Since our formation in 2015, our Chapters have shared some significant best practice programs, including: Post-Acute Care Program (Bronson Healthcare) and Congestive Health Failure Program (Sparrow Health System)

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Sparrow is a not-for-profit, community focused, comprehensive health system and major teaching hospital. Providing quality care to tens of thousands of people each year, Sparrow has two Lansing campuses plus Sparrow Clinton Hospital, Sparrow Ionia Hospital, Sparrow Carson Hospital, and an affiliate hospital, Hayes Green Beach. The health system also includes dozens of satellite care centers and the only hospital-based health club in mid-Michigan, the Michigan Athletic Club. Sparrow Care Network In 2014, Sparrow and physician leaders initiated the creation of Sparrow Care Network (SCN), a physician-led Clinically Integrated Organization. SCN has grown to include 650 independent and employed physicians who care for over 250,000 lives across seven mid-Michigan counties. Partnering with eight hospitals, 14 preferred skilled nursing facilities, and several community resources, and building on the belief that improving the quality and efficiency of care is most effective when it’s physician-led, SCN is a testament to the power of collaboration and physician leadership.

OPIOID COLLABORATIVE CARE WORKGROUP Sparrow joined the Mayo Clinic Care Network Acute Opioid Reduction Collaborative to reduce opioid prescribing at discharge. As part of a system-wide strategy to combat the opioid epidemic locally, Sparrow designed a three-pronged approach for acute prescribing. With the goal of reducing the risk of dependency and educating patients on appropriate disposal, the approach included: • Reducing the current level and variation of opioids prescribed at discharge • Delivering comprehensive educational tools

• Creating a robust network within the community for the disposal of excess opioids

Under the leadership of Brian McCardel, M.D., and in collaboration with physician leaders in Orthopedics, Neurosurgery and General Surgery:


• Evidence-based guidelines were created limiting opioid prescriptions to the lowest dose and quantity necessary to treat acute pain • Standardized patient education materials were approved for the inpatient setting

• Work began to implement an Opioid Disposal Program at Sparrow Pharmacy locations • Sparrow hosted a successful Medication Take Back Event • Opioid Best Practice for prescribing was finalized

MidMichigan Collaborative Care Organization The MidMichigan Clinically Integrated Network (CIN) is organized and governed within MidMichigan Collaborative Care Organization, the health system’s platform for population health and value based programming.


Headquartered in Midland, Michigan, MidMichigan Health is affiliated with Michigan Medicine, the healthcare division of the University of Michigan. The health system covers a 23-county region with medical centers in Alpena, Alma, Clare, Gladwin, Midland, Mt. Pleasant and West Branch. In addition to our medical centers, MidMichigan Health also offers both home health care and physician services, and has a strong commitment to medical education. MidMichigan Physicians Group provides urgent care and medical offices in more than 30 specialties and subspecialties.

NOTABLE INITIATIVES The MidMichigan Collaborative Care Organization made great progress in 2018: • Care management expansion to every primary care practice with addition of patient care navigators and behavioral health support • Deployment of an ambulatory risk prediction tool within the EMR • Screening tool to identify social determinants of health • Community-Based Advance Care Planning program • Multifaceted approach to managing the opioid epidemic • Virtual and in-person Diabetes Prevention Program • Key behavioral health and substance use programs; Zero Suicide, Project ASSERT (substance use counselor at point of care in ED) and counselors in ambulatory and inpatient psychiatry settings • Bridge to Belonging - an innovative program to identify ‘loneliness’ and develop a protocol to assist those individuals who screened positive • ‘Transformation Initiative’ designed to enhance the quality, safety and efficiency of acute care services • Successful participation in the Medicare Shared Savings Program through Physician Organization of Michigan Accountable Care Organization. $45 million saved with over $20 million earned in shared savings. 23


Spectrum Health Lakeland, a division of Spectrum Health, is a not-for-profit, community-owned health system, which includes three hospitals, an outpatient surgery center, rehabilitation services, homecare, hospice and palliative care, long-term care, laboratory services, diagnostic imaging, and a number of primary and specialty physician practices. The history of Lakeland dates back more than a century, when our hospitals first began meeting the needs of southwest Michigan residents. Today, Lakeland continually works to create an integrated system of care that is accessible, affordable, compassionate, and responsible. Lakeland Care Network is a Physician Hospital Organization (PHO) serving the healthcare needs of southwest Michigan communities. Lakeland Care Network includes over 80 primary care physicians, over 150 specialty physicians, all Lakeland hospital services, and a wide range of insurance options.

SPEAKER SERIES HIGHLIGHTS EFFECTS OF RACISM, TRAUMA ON HEALTH In Berrien County, poor people, especially African Americans, experience high rates of illness and early death. Data provided by the Berrien County Health Department finds blacks have higher rates of obesity, diabetes, stroke, and psychological distress when compared to whites. While these differences are attributable to poor access to resources required for good health such as healthy food, quality education, and safe housing, emerging science suggests that the experience of discrimination is strongly associated with health inequities. In an effort to improve the health of our community and shed light on the impact trauma and racism has on health, Spectrum Health Lakeland, in partnership with The Todman Family Foundation, established Community Grand Rounds: Healing the Trauma of Racism. Launched in 2018 and concluding in 2020, the speaker series addresses the health implications of psychological trauma and racism as well as the emerging science of epigenetics and social genomics. In fiscal year 2018, 750 people attended a Community Grand Rounds speaker series event.


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Henry Ford Physician Network (HFPN), founded in 2010, is a physician-led Henry Ford clinically integrated network (CIN), comprised of the Henry Ford Medical Group, Henry Ford hospital-employed and private practice physicians. The 1,900+ members of this CIN focus on delivering high quality care while reducing medical costs. Jackson Health Network is a collaboration between healthcare leaders, community leaders and physicians working together to improve patient outcomes and safety, and reduce overall costs through an integrated system of care.


As one of the nation’s leading comprehensive, integrated health systems recognized for clinical excellence and innovation, we provide both health insurance and healthcare delivery, including acute, specialty, primary and preventive care services backed by excellence in research and education.

HENRY FORD HEALTH SYSTEM DIRECT-TO-EMPLOYER CONTRACT Henry Ford Health System (HFHS) and the Henry Ford Physician Network (HFPN) have partnered with General Motors to offer a new health care product (ConnectedCare) to thousands of employees in Southeast Michigan. The product launched on January 1, 2019 as the first major direct-to-employer contract for Henry Ford and the only one in Michigan for General Motors. ConnectedCare offers enrolled GM employees greater value by lowering premium and out-of-pocket costs for staying within the HFPN for health care. HFHS and HFPN succeeded in winning this contract based on demonstrated success in previous value-based contracts with CMS (Next Generation ACO) as well as commercial ACO contracts with HAP.

JHN ENGAGES TWO LOCAL EMPLOYERS Jackson Health Network (JHN) supports the local medical community to consistently achieve the quadruple aim: improved outcomes, improved experience of care, lower per capita cost of care, and supporting the health and welfare of Jackson care providers. In 2018, JHN and two local employers introduced a package of services to bring these components together. This concept, value-based contracting, incorporates significant interventions to improve care delivery with a unique benefit structure and guarantees specific to total cost of care. JHN also expanded coordination with local social and governmental agencies in 2018, addressing social determinants of health to allow individuals more successful management of their own well-being. To support provider efforts in removing non-value-added health care and redesigning care delivery options, beneficiaries are encouraged to utilize JHN providers to improve care coordination, attend health education sessions, utilize JHN Care Managers, and optimize preventive and chronic care services.



From moms-to-be, to babies, to great-grandfathers, the Covenant HealthCare mission is to provide extraordinary care for every generation. The Saginaw-based health system leads in offering a broad spectrum of programs and services for the entire family, including high-risk obstetrics, neonatal and pediatric intensive care, acute care, a Level II Adult and Pediatric Trauma Center, cardiology, oncology, orthopaedics, robotic surgery, virtual care and more. Extraordinary care goes beyond outstanding medical services, it’s a compassionate and caring team that makes the difference. The Covenant team lives our WE CARE values— putting patients at the center of every decision. Covenant is proud to work with local physicians and providers to bring world class health care, close to home. Covenant HealthCare Partners provides patients with the extraordinary care they need to stay healthy. Choose a doctor through Covenant HealthCare Partners and get the health care you have been looking for.

ENHANCING CARE FOR SENIORS The population of seniors in the United States has been growing steadily since 2011. Today individuals 65 and older represent 16.7 percent of Michigan’s population, and that number is expected to continue to swell for many years to come. Recognizing the special needs of older adults in the emergency care setting, Covenant HealthCare added the Great Lakes Bay Region’s first Senior Emergency Care Center in 2017. The Covenant Emergency Team wanted to take this further, continuing to enhance senior emergency care and applying for Geriatric Emergency Department Accreditation (GEDA) from the American College of Emergency Physicians (ACEP). This year, Covenant Emergency Care Center achieved the Bronze Standard – Level 3 GEDA Accreditation. Covenant is the second hospital in the state of Michigan to obtain this accreditation, and the only hospital in our region. Covenant believes providing specialized patient-centric care for seniors improves outcomes, reduces readmissions and enhances overall patient experience. 26

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The system provides care in virtually every specialty with advanced capabilities as a Level I trauma center, Joint Commission certified comprehensive stroke center, accredited chest pain emergency center, American College of Surgeons accredited community hospital comprehensive cancer program, and the only high-risk pregnancy center and children’s hospital in southwest Michigan.


Bronson Healthcare is a not-for-profit, community-governed health system serving nine counties in southwest and south central Michigan. With 9,000 employees, four acute care hospitals, more than 1,300 medical staff members, and 836 licensed beds, Bronson is the largest employer in southwest Michigan. Bronson offers a full range of services from primary care to critical care across more than 70 locations.

Bronson Network works directly with independent and employed physicians in southwest Michigan to improve clinical outcomes, cost and quality of care.

BRONSON SKILLED NURSING ROUNDING PROGRAM The Bronson Healthcare system implemented a post-acute care network in 2015 to improve management of high risk patients. The skilled nursing rounding program is a key component. Over the past three years, Bronson Geriatric Medicine providers have served hospital discharged patients at Bronson Commons, five partner skilled nursing facilities, home care, home based advanced illness management and hospice. More than 1,600 patients were admitted to the program in 2018 which accounts for 42% of the system’s SNF discharges. The program aims to capture 50% in 2019. Comparison of data across Affirmant chapters identified Bronson Network’s overall lower hospital utilization for patients discharged to SNFs for post-acute care. Patients in the program also have a decreased SNF length of stay and lower readmission rate than the state and national averages.

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We could not achieve our vision of a healthy Michigan at an affordable cost without the dedication and leadership of our colleagues and high-performing teams. With the Leadership Awards, we recognize team members who demonstrate our core values and bring us closer to our vision. 



We are leaders in quality, and hold ourselves and our partners to the highest standards and performance.

We support, empower and leverage our high-performing teams.

Dan Cramer Covenant HealthCare Partners Mary Greeley, RD MidMichigan Collaborative Care Organization Nicole Allen Sparrow Care Network

Bronson IT Department Jackson Health Network Sherry Walling Ali Aldridge Jessica Cox Brittany Easton Donna Eberly-Paquette Molly Fleming, MSN, RN Kristin Jervis Jill Li Laurie Tarpley Pam Wyatt-Elkins, MBA

Lakeland Care Network Samantha Fell Jordan Zaluckyj Jill Frey Rachel Sunday Emily Ulrath Spectrum Health Lakeland Christopher Johnson Kathy Starbuck Lenee Svorec Abigail Tippin Laura Wagner Megan Yore, MA, PCM®


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for living our values!




We seek to understand and respect our patients, colleagues and community partners.

We learn, teach and adopt evidence-based best practices.

We inspire and enable rapid improvement.

Ash Goel, MD Bronson Network

Information Technology and Business Intelligence Committee Visit page 35 for complete list of members

Becky Trella, RN Bronson Network Margaret Brown, RN Jackson Health Network

Mary Whitbread Henry Ford Health System Post Acute Care Workgroup Visit page 34 for complete list of members

Samantha Fell Lakeland Care Network Pankaj Jandwani, MD MidMichigan Collaborative Care Organization

POSTER AWARD WINNERS Best Poster & People’s Choice Implementation and Impact of Bronson Post-Acute Care Network Bronson Healthcare

Honorable Mention Vital Signs Integration:Â Capturing Vital Signs Directly into Epic from Philips Devices Spectrum Health Lakeland

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Affirmant Board of Managers Kevin Albosta Covenant HealthCare

Wright Lassiter, III Henry Ford Health System

Ken O’Neill, MD Spectrum Health Lakeland

Georgia Fojtasek (Advisor), RN Henry Ford Allegiance Health

Madhura Mansabdar, MD MidMichigan Health

Diane Postler-Slattery, PhD MidMichigan Health

Loren B. Hamel, MD Spectrum Health Lakeland

William Mayer, MD, MPH Affirmant Health Partners

Frank Sardone Bronson Healthcare

Ray King, MD Henry Ford Allegiance Health

Bruce Muma (Advisor), MD Henry Ford Health System

Michael Slavin, MD Covenant HealthCare

Scott Larson, MD Bronson Healthcare

Harman Nagler, MD, MHSA Sparrow Health System

Dennis Swan, JD Sparrow Health System

Loren B. Hamel, MD Spectrum Health Lakeland Chairperson

Diane Postler-Slattery MidMichigan Health Vice Chairperson

Wright Lassiter, III Henry Ford Health System Treasurer

Michael Slavin, MD Covenant HealthCare Secretary

Thank you for serving as leaders and ambassadors to Affirmant Health Partners. Best wishes in your retirement!

Dennis Swan, JD President and CEO, Sparrow Health System, Founding Board Chairperson for Affirmant


Harman Nagler, MD, MHSA Vice President of Clinical Integration, Sparrow Care Network, Founding Board Member for Affirmant

Board and Committee Members on pages 31-35 are listed with their associated local Chapters

Federation ACO Board of Managers

Chapter Operations Committee

Communications & Education Committee

Kevin Albosta Covenant HealthCare Partners

Gayle Biederman Covenant HealthCare Partners

Dawn Anderson-Meier Jackson Health Network

Jerry Booth, DDS Jackson Health Network

Samantha Fell Lakeland Care Network

Becca Blanken Henry Ford Physician Network

Sharon Deskins, MD Lakeland Care Network

Mary Greeley, RD MidMichigan Collaborative Care Organization

Kathy Bouchard-Wyant, RN Sparrow Care Network

Douglas Edema, MD Sparrow Care Network Ron Gonzales, MD Covenant HealthCare Partners David Halsey, MD Jackson Health Network Wynn Hazen Jackson Health Network John Jones, MD Bronson Network

Wynn Hazen Jackson Health Network Ray King, MD Jackson Health Network Melissa Kurtz Henry Ford Physician Network Scott Larson, MD Bronson Network

Ray King, MD Jackson Health Network

Madhura Mansabdar, MD MidMichigan Collaborative Care Organization

Scott Larson, MD Bronson Network

Bruce Muma, MD Henry Ford Physician Network

William Mayer, MD, MPH Affirmant Health Partners

Harman Nagler, MD, MHSA Sparrow Care Network

Harman Nagler, MD, MHSA Sparrow Care Network

Ken O’Neill, MD Lakeland Care Network

Ken O’Neill, MD Lakeland Care Network

Michael Slavin, MD Covenant HealthCare Partners

Sacha Crowley Sparrow Care Network Larry Daly Covenant HealthCare Partners


Board and Committee Members as of December 31, 2018

Rose Glenn Henry Ford Physician Network Warren Johnson MidMichigan Collaborative Care Organization Peter May Jackson Health Network Sandra Plank, DNP, RN Lakeland Care Network Marijo Snyder, MD Bronson Network Susan Watts Bronson Network Megan Yore, MA, PCM® Lakeland Care Network

Mike Tobin Sparrow Care Network Nancy Vannest Bronson Network Affirmant Health Partners



Clinical Transformation Committee

Measures Development Subcommittee

Evidence-Based Best Practice Subcommittee

Karen Bennett, BSN, RN Sparrow Care Network

Nicole Allen Sparrow Care Network

Nicole Allen Sparrow Care Network

Bethany Charlton Covenant HealthCare Partners

Karen Bennett, BSN, RN Sparrow Care Network

Sharon Deskins, MD Lakeland Care Network

Samantha Fell Lakeland Care Network

Eugene Berezovsky Henry Ford Physician Network

Kenneth Edwards, MD Lakeland Care Network

Peter Graham, MD Sparrow Care Network

Gayle Biederman Covenant HealthCare Partners

Peter Graham, MD Sparrow Care Network

Mary Greeley, RD MidMichigan Collaborative Care Organization

Dan Cramer Covenant HealthCare Partners

Paula Grudt, RN Bronson Network

Samantha Fell Lakeland Care Network

Sean Kesterson, MD MidMichigan Collaborative Care Organization

Paula Grudt, RN Bronson Network David Halsey, MD Jackson Health Network Scott Larson, MD Bronson Network Joyce Leon, MD, FACP, CPE Henry Ford Physician Network Bruce Muma, MD Henry Ford Physician Network Harman Nagler, MD, MHSA Sparrow Care Network Ken O’Neill, MD Lakeland Care Network Joanna Pease, DO Henry Ford Physician Network Amy Schulz, MD, MPH Jackson Health Network Michael Sullivan, MD Covenant HealthCare Partners Lydia Watson, MD MidMichigan Collaborative Care Organization


Affirmant Health Partners

Molly Fleming, MSN, RN Jackson Health Network Mike Getty Spectrum Health Lakeland Ash Goel, MD Bronson Network Paula Grudt, RN Bronson Network Melissa Kurtz Henry Ford Physician Network Megan Piotrowski Jackson Health Network Kendall Troyer Lakeland Care Network Brenda Turner MidMichigan Collaborative Care Organization Kay Wagner, DHA, MSN, RN MidMichigan Collaborative Care Organization Pam Wyatt-Elkins, MBA Jackson Health Network

Scott Larson, MD Bronson Network Madhura Mansabdar, MD MidMichigan Collaborative Care Organization Dan Moore, MD Henry Ford Physician Network Harman Nagler, MD, MHSA Sparrow Care Network Arvind Prabhu, MD Jackson Health Network Furqan Siddiqi, MD Lakeland Care Network Alan Spencer Covenant HealthCare Partners Anish Wadhwa, MD Jackson Health Network Michael Williams, DO, FHM, RPh Covenant HealthCare Partners

Best Practice Learning Collaborative - Care Management

Josh Ford, PharmD Lakeland Care Network Rox Gatia II, PharmD Henry Ford Physician Network Peter Graham, MD Sparrow Care Network Ryan LaLonde, PharmD, MBA MidMichigan Collaborative Care Organization Jason Lovero, PharmD Lakeland Care Network Glenda Pietryga, PharmD Bronson Network Vanita Pindolia, PharmD, MBA Henry Ford Physician Network Troy Thomspon, MD Lakeland Care Network Mark Touchette, PharmD Jackson Health Network Holly Wagner, PharmD Bronson Network Joy Wahawisan, PharmD Sparrow Care Network Terry Wernette, PharmD Covenant HealthCare Partners Michael Williams, DO, FHM, RPh Covenant HealthCare Partners Ellen VanStee, RPh, MBA Jackson Health Network

Rebecca Allen, BSN, RN Covenant HealthCare Partners

Taryn Jobson Covenant HealthCare Partners

Nancy Arce, LMSW Jackson Health Network

Ray King, MD Jackson Health Network

Gayle Biederman Covenant HealthCare Partners

Michael Klinkman, MD Jackson Health Network

Christine Billings, BSN, RN Covenant HealthCare Partners

Joe Maher Jackson Health Network

Kathy Bouchard-Wyant, RN Sparrow Care Network

Madhura Mansabdar, MD MidMichigan Collaborative Care Organization

Margaret Brown, RN Jackson Health Network Kathy Bruzewski MidMichigan Collaborative Care Organization

Cathleen Merling, RN Covenant HealthCare Partners Tammy Minor Covenant HealthCare Partners

Shirley Cardinal, RN Covenant HealthCare Partners

Ken O’Neill, MD Lakeland Care Network

Samantha Fell Lakeland Care Network

Amy Pierman, MSN, RN Bronson Network

Victoria Felton, RN Lakeland Care Network

Karen Riley Lakeland Care Network

Beth Fiskars Lakeland Care Network

Kimberly Ross Covenant HealthCare Partners

Steven Frazier, RN MidMichigan Collaborative Care Organization

Jennifer Schmitt Lakeland Care Network

Candace Graham, MSN, RN Lakeland Care Network

Gayatri Shanker Covenant HealthCare Partners

Paula Grudt, RN Bronson Network

Brenda Turner, RD MidMichigan Collaborative Care Organization

Heidi Hanel Covenant HealthCare Partners

Pamela Warfle Sparrow Care Network

Partricia Hill, BSN, RN Covenant HealthCare Partners

Caitlin Yanakeff, LMSW Jackson Health Network

Kelsey Hoffman Sparrow Care Network


Pharmacy and Safety Subgroup

Affirmant Health Partners



Post-Acute Care Workgroup Rachel Aultman, BSN, RN MidMichigan Collaborative Care Organization Rob Behrendt, BSN, RN Henry Ford Physician Network Megan Black Sparrow Care Network Sue Craft, BSN, RN Henry Ford Physician Network Lisa Deehan, BSN, RN Jackson Health Network Candace Graham, MSN, RN Lakeland Care Network Melinda Gruber, MBA, PhD Lakeland Care Network Morgan Martin, MHA, CPHQ Sparrow Care Network Anna Melville, MA, RD Sparrow Care Network

Finance & Contracting Committee Kevin Albosta Covenant HealthCare Partners Laurie Babinski MidMichigan Collaborative Care Organization Gayle Biederman Covenant HealthCare Partners Tim Calhoun Lakeland Care Network Rebecca East Bronson Network Lowell Hamel, MD Lakeland Care Network Wynn Hazen Jackson Health Network Melissa Kurtz Henry Ford Physician Network

Michelle Reed, LMSW Covenant HealthCare Partners

Francine Padgett MidMichigan Collaborative Care Organization

Becky Trella, MSN, RN Bronson Network

Paula Reichle Sparrow Care Network

Pam Wyatt-Elkins, MBA Jackson Health Network

Amy Shulz, MD, MPH Jackson Health Network Kevin Sharp Sparrow Care Network Amy Vandecar Henry Ford Physician Network Nancy Vannest Bronson Network


Affirmant Health Partners

David Allard Henry Ford Physician Network

Renee Hoyt Sparrow Care Network

Eric Pierce Covenant HealthCare Partners

Ken Arnold Covenant HealthCare Partners

John Hulsebus Lakeland Care Network

Robin Sarkar, PhD Lakeland Care Network

Eugene Berezovsky Henry Ford Physician Network

Matt Hussmann Henry Ford Physician Network

Holly Schewe Spectrum Health Lakeland

Thomas Bres Sparrow Care Network

Pankaj Jandwani, MD MidMichigan Health Network

Kathleen Smith Sparrow Care Network

Sheila Britney Bronson Network

Smita Jha Sparrow Care Network

Robert Spitz MidMichigan Health Network

Ken Buechele Bronson Network

Janet Kummeth MidMichigan Health Network

Erin Stern MidMichigan Health Network

Meghan Cole Bronson Network

Jia Li Jackson Health Network

Mindy Stokoszynski Covenant HealthCare Partners

Stephen Connellee Bronson Network

Chris McNees Lakeland Care Network

Sarah Travis MidMichigan Health Network

Dan Cramer Covenant HealthCare Partners

Gregory Meece Sparrow Care Network

Abbigail Van Andel Jackson Health Network

Frank Fear Covenant HealthCare Partners

Matthew Mitchell MidMichigan Health Network

Dan Waltz MidMichigan Health Network

Michael Getty Lakeland Care Network

Adam Passig Lakeland Care Network

Steve Withers Bronson Network

Ash Goel, MD Bronson Network

Ed Patnode Covenant HealthCare Partners

Aaron Wootton Jackson Health Network

Tim Grove, MBA Lakeland Care Network


Information Technology & Business Intelligence Committee

Michael Zaroukian, MD, PhD Sparrow Care Network

Wynn Hazen Jackson Health Network

Affirmant Health Partners



Bill Mayer, MD, MPH President and CEO

Erik Pye Executive Assistant

Executive Assistant

Karin Proos, PharmD

Lawrence Green, AM, MBA

Katy Velten

Paul Peabody

Director of Clinical Transformation

Director of Payor Strategy

Director of Communications

Information Technology and Business Intelligence Executive

Andrea Charlton, LMSW, MPH

Jeromy Timmer

Meghan Gaertner

Angela Johnson

Clinical Transformation Consultant

Manager of Information Technology

Communications Specialist

Clinical Transformation Consultant


Rose Campbell Blackwood

Affirmant Health Partners

950 Trade Centre Way Suite 200 Portage, MI 49002

(877) 232-3614

@Affirmant Affirmant Health Partners info@affirmant.com


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