It's a new kind of health care.

It has a regional focus that draws together a large pool of patients.

It joins health care organizations in Lancaster County and York County, but the care will remain locally based in both communities.

It works under an incentive to keep patients well, not just care for them when they are sick.

Those are some of the goals of the recently announced affiliation between Ephrata Community Hospital and WellSpan Health in York.

The affiliation likely means new services and programs in Ephrata, such as robotic surgery, new interventional cardiac services and more private patient rooms, due to an infusion of funding from WellSpan, local officials say.

Though it is partnering with an organization that is 40 miles away, the Ephrata hospital will retain its local focus.

Patients will stay in Lancaster County, hospital jobs will be preserved and local donations will stay in the community, officials say.

Business people in another county where WellSpan operates say a similar partnership has done good things for their community.

But a Lancaster County business group leader said he hopes the partnership doesn't lead to increased costs here.

WellSpan Health will be a new player in the local health care market, home to four hospitals: Ephrata, Lancaster General Hospital, Lancaster Regional Medical Center and Heart of Lancaster Regional Medical Center.

Based in York, the WellSpan organization has a big reach and more than 9,000 employees, physicians and volunteers.

WellSpan operates WellSpan York Hospital, WellSpan Gettysburg Hospital and WellSpan Surgery & Rehabilitation Hospital. It also operates a medical group with 500 providers and 35 outpatient health care centers.

The proposed affiliation here was spurred in part by changes in health care directed by President Obama's Affordable Care Act, which encourages doctors and hospitals to join in groups, called "accountable care organizations, "to cover large numbers of patients, Ephrata's president and chief executive officer John Porter said.

The groups are designed to reduce health care costs by forming a network that shares responsibility for providing care to patients.

The organization is paid a flat fee per patient for that care and is rewarded by keeping patients well, instead of providing expensive care for them when they are sick.

To be an effective ACO, Porter said, an organization needs to have 1 million to 1.5 million patients in a pool, to spread out the risk of high-risk or very ill patients. Ephrata did not have that large of a pool.

"Our board said ... we need to identify a partner that can best help us get there, and keep us a community-based asset," Porter said.

Ephrata began searching for a partner several years ago, as it began thinking about how it could best position itself to deliver health care in a changing market, Porter said.

It tried twice, in 2008 and 2010, to join forces with Lancaster General Health, a health care organization that is similar in size and scope to WellSpan. But state and federal officials said such a relationship would create too much of a monopoly on health care here, he said.

"We wanted to do it with Lancaster General because that's the natural flow for patients," Porter said. "When we can't serve someone's interest, it's most likely served at LGH."

When Ephrata realized that government officials would not approve such a marriage, it began looking for a new partner, meeting with 14 different health care organizations in Reading, Harrisburg and surrounding areas.

WellSpan turned out to be the best fit, Porter said. Its focus on community health was very similar. It had a similar governing system. It also had the same ideas about the ACO model.

And it had one philosophy that was very important to Ephrata, Porter said.

"WellSpan wants people to seek service at the local level," he said. "They are not expecting people to drive to York for services we don't offer. They want us to use the current relationships.

"So, if a person comes into the ER, is evaluated and needs open-heart surgery, the patient will go to Lancaster General," he said.

Ephrata doesn't plan to add complex new services such as open-heart surgery or trauma care, already offered here, Porter said. But it will expand its services in other areas.

The full details are being worked out but robotic surgery, expanded private rooms and cardiac services likely will be added, Porter said. The hospital will evaluate its outpatient services, women's health, behavioral health and cancer services to see if they need to be expanded.

Ephrata doesn't plan to cut clinical jobs, Porter said. But business and administrative positions ultimately may be cut through attrition, he said.

Porter said he will stay on in his role, but will have access to WellSpan's executive team.

A foundation will be established for local donations so that those stay in the community, he added.

And the hospital will not change its name, though it could add something to reflect its affiliation with WellSpan.

The head of a local business group wonders if the proposed affiliation could lead to unnecessary costs here, even though Ephrata is positioning itself according to the federal law's intent.

Because ACOs need to provide a continuum of care to patients, they may offer some services already provided in a community, said Jim Schmucker, executive director of the Lancaster County Business Group on Health.

The local community already has numerous outpatient centers, surgical services and other health care offerings.

"The two challenges that any business group and consumer markets are faced with are accessibility and affordability," he said. "To that end, any collaboration or partnership that highlights those two areas, we are 100 percent behind.

"But what I hear, superficially, is we need access to higher-end things, bigger and more expensive technology, and that doesn't help accessibility and affordability. ... That concerns us."

Business people in Adams County applaud the accessibility that WellSpan has brought to their community since its affiliation with Gettysburg Hospital in 1999.

The market in Adams County is different than the local one, with only one hospital there, as opposed to the four in Lancaster County. With 76 beds, Gettysburg is also smaller than Ephrata, which has 130 beds.

Greg Allen, board chairman of the Gettysburg Adams Chamber of Commerce, said people were "cautiously optimistic" when WellSpan affiliated with Gettysburg Hospital, but a bit hesitant about the move.

"We felt the hospital was pretty solid as it was," said Allen, chief executive officer of graphcom, a printing, graphic design and advertising firm. "I think there were some who questioned why (the affiliation) was necessary."

"There was a feeling of, are we going to lose our hospital? Is it no longer going to be our hospital? That hasn't been the case at all."

Allen said WellSpan won people over, bringing in services, doctors' offices and a surgery center, things Gettysburg Hospital likely would not have been able to do on its own.

As far as effects on cost, Allen said he doesn't think WellSpan has had a significant impact one way or another.

Karen Re, benefits specialist for Gettysburg College, said many of the college's 750 full-time employees use the services of WellSpan, which provides a behavioral health service plan to the college as well as an annual blood screening.

"It's been a good partnership," she said.

Carrie Stuart, the chamber president, agreed, saying WellSpan has supported a group called Healthy Adams County that seeks to identify unmet health needs.

The affiliation requires regulatory approval. The plan is to complete an agreement by early next year, develop plans and submit them for approval, with a completion possibly by the end of next year.
cstauffer@lnpnews.com