For many years, health care costs have outpaced inflation by a wide margin. In many areas of the country, unfortunately, increases in quality have not necessarily accompanied these increases in cost. Consumers just feel they are paying more.
To improve the quality of health care and help “bend the trend” of rising costs, Wellmark began establishing accountable care organizations (ACOs) in 2012. This page provides news and special features about Wellmark’s nine ACOs, describes how ACOs work and demonstrates how ACOs contribute to a more sustainable health care system.
News and Special Features
What is an ACO?
An accountable care organization (ACO) is a local health care organization that is held accountable for the quality and cost of the care it delivers. Some important characteristics of ACOs include:
- ACOs have a strong base of primary care physicians. These are providers you see regularly and might call “my doctor.”
- Doctors aren’t just accountable for caring for patients when they are sick. They also focus on keeping you as well as possible for as long as possible.
- ACOs receive payments linked to quality improvements that also reduce the rate of increase in health care costs. For example, helping a patient manage his diabetes is both high quality health care and prevents expensive complications such as blindness or amputations.
- Performance measurements ensure that savings are achieved through improvements in care.
What is the connection between quality and cost?
Health care isn’t like other services or products. When it comes to ACOs, quality health care = better outcomes + lower costs. Unlike a luxury car or first class airplane ticket, “expensive” doesn’t necessarily mean “better.” For example, regular trips to your doctor to prevent or manage a serious illness — high blood pressure, for example — can help you enjoy a better quality of life and avoid expensive surgeries or trips to the emergency room. It’s all about providing the right care at the right time.
What is the impact to members?
In their first two years of operation, Wellmark’s first five ACOs improved their quality scores by more than 35 percent and saved more than $12 million. They accomplished this by reducing hospital admissions by nearly 12 percent, readmissions by 7 percent, and emergency department visits by nearly 11 percent. It’s all based on a commitment to:
- Quality outcomes. Wellmark ACOs keep healthy people well and improve the outcomes for Wellmark members when they need care.
- Better patient experiences. Doctors in Wellmark ACOs strive to ensure all appropriate care is received in a timely manner. They also help patients stay engaged in the care they receive and that they understand the costs.
- Reduced rate of increase. Wellmark supports ACO providers' efforts in lowering costs without compromising care. In addition, Wellmark shares any cost savings with the ACOs.
How do ACOs accomplish better quality care?
The impact to members doesn’t happen overnight. Rather, the focus of an ACO arrangement is a gradual and subtle improvement in the attention and care people receive. This includes:
- Prevention: Proactive outreach to ensure that healthy people remain healthy by getting regular exams and immunizations, and by participating in programs designed to keep them well.
- Care Coordination: Seamless patient experience when setting an appointment, seeing multiple doctors and receiving follow-up care.
- Patient Engagement: Providers encouraging patients and their caregivers to take an active role in their health care.
How many members and providers are involved in Wellmark ACOs?
More than 460,000 Wellmark members receive care through Wellmark’s nine ACOs. With more than 1,500 personal doctors serving these members, Wellmark ACOs include:
- Family Health Care of Siouxland, PLC
- Genesis Health System
- McFarland Clinic
- Mercy Medical Center — Cedar Rapids/University of Iowa
- Mercy Medical Center — Des Moines
- Mercy Medical Center — Mason City
- The Iowa Clinic
- UnityPoint Health
- Wheaton Franciscan Healthcare