An accountable care organization (ACO) is a local health care organization that is held accountable for the quality and cost of care delivered to a defined population.
ACOs have three key characteristics:
- Provider-led organizations with a strong base of primary care physicians who are collectively accountable for quality and total per capita costs across the full continuum of care for a population.
- Payments linked to quality improvements that also reduce the rate of increase in health care costs.
- Reliable and progressively more sophisticated performance measurement to support improvement and provide confidence that savings are achieved through improvements in care.
Wellmark’s ACO Payment Strategy
Wellmark is collaborating with five health systems in an ACO payment system focused on improving the health care experience and slowing the rate in health care cost increases. The ACO arrangements were created to keep healthy people well and improve outcomes for our members when they need care. Wellmark is collaborating with the following health systems:
UnityPoint Health, UnityPoint Clinic, UnityPoint at Home and aligned independent health care providers in the following communities:
- Cedar Rapids
- Des Moines
- Fort Dodge
- Quad Cities
- Mercy Medical Center – Des Moines, affiliated medical clinics, and home health care services
- Genesis Health System – Davenport, affiliated medical clinics, and home health care services
- Wheaton Franciscan Healthcare – Waterloo, Covenant Medical Center
Mercy Medical Center – Cedar Rapids/University of Iowa
- Cedar Rapids (Mercy Medical Center)
- Iowa City (University of Iowa Hospitals and Clinics)
The Goals of Wellmark’s ACO Strategy
Wellmark’s ACO strategy will enhance Wellmark members’ care in a variety of ways:
- Quality outcomes. Keep healthy people well and improve the outcomes for Wellmark members when they need care.
- Better experience/more informed patient. Ensure all appropriate care is received in a timely manner and that patients are actively engaged in the care they receive and understand the costs.
- Reduce the rate of increase. Wellmark will support participating providers’ efforts in lowering costs without compromising care. In addition, Wellmark will share any cost savings with the ACOs.
The Focus of our ACO Strategy
The focus of an ACO arrangement is a gradual and subtle improvement in the attention and care people receive from their health care provider, such as:
- Prevention: Proactive outreach to ensure that healthy people remain healthy by obtaining regular exams and immunizations, and by participating in preventive programs.
- 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 does Wellmark’s ACO strategy differ from managed care approaches of the past?
- There are incentives for providers to deliver better care more efficiently.
- There are no incentives to withhold medically necessary care.
- An ACO is not a health plan or managed care plan – people retain their choice of physicians and other health care providers.
- The ACO is structured as a collaborative effort in which Wellmark supports the ACO in its efforts to provide appropriate and cost effective care.