Pineridge Quality Alliance

Taylor Webster

Pineridge Case Brief

Jan 30, 2018

Problem Statement

The problem the board of the Pineridge Quality Alliance (PQA) faced was that in order to establish an Accountable Care Organization, their clinically integrated network would still need to improve and further expand. This expansion would require large investments of time, money, and resources beyond what had already been invested. Further development of the PQA would also require expansions of contracts with various providers and payers, which proved to be somewhat difficult due to their geographic location.

Case Names and Roles

Brent Priday was a newly appointed CEO at Pineridge Medical Center in 2012 and a board member of the PQA. The PQA board comprised of nine members, six of which were physicians. These members included Brock Bailey, Camila Wixom, Donald Davis, Alexis Gomez, Ray Marriott, Mia Wesley, Brent Priday, Jake Abram, and Luciana Martinez. Karlyn Nortin become Pineridge Quality Alliance’s first full-time executive director in 2014.

Background and Facts

Pineridge Medical Center, located in Pineridge, Idaho, was designated a new CEO in 2012. The new CEO and the board of directors had to determine how the organization would adapt and reorganize because new legislation was causing rapid change in the healthcare system and payment models were transitioning from volume based to value based. Their solution was to develop the Pineridge Quality Alliance, a clinically integrated network dedicated to efficiency, lowering costs, and improving quality. As the PQA has grown and expanded, the board of directors had identified a handful of challenges they must confront, in order to meet desired results.

Organizational Issues

A major organizational issue the PQA faced was inadequate resources. Although they had already invested millions of dollars and thousands of hours for work, they had not achieved their desired outcomes and still needed to invest more. The organization also faced issues with providers utilizing the data system established to improve patient care, due to lack of provider understanding of system.

Decision/Resolution

At a meeting, the PQA board discussed challenges and decided on several broad goals for the upcoming years. Establishing these goals was intended to help them further develop the clinically integrated network through various methods.

Reasoning

The board believed the goals set would help them develop and improve the PQA which would ultimately improve patient outcomes and the quality of care provided, while lowering overall costs. These changes would allow them to better navigate the transition from volume based payment to value based payment.

Outcome

The goals set by the board would help increase provider network participation, improve data access, improve patient outcomes, and increase efficiency. I would categorize the outcome as satisfactory. Although it is unclear how the goals set by the board may be achieved, determining the areas for improvement and acknowledging weaknesses will help the organization know where to focus their resources.