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September 04, 2015

DES MOINES, IA (Sept. 3, 2015) – Rewarding health systems for collaborating to improve quality of care and effectively manage costs is continuing to make a measurable difference according to Wellmark Blue Cross and Blue Shield’s 2014 Accountable Care Organization (ACO) Shared Savings model data released today. Eight participating ACOs have improved their overall quality scores by eight percent and saved more than $17 million during 2014.

“Wellmark’s ACO shared savings model continues to be a critical component of our strategy to work collaboratively with physicians and hospitals to promote high quality care for our members,” said Mike Fay, vice president, health networks. “We are pleased and encouraged by the 2014 results and our members should be too because this ultimately leads to better value for their health care dollar.”

ACOs are designed to improve the quality of care, provide greater value and slow increases in health care costs. ACO providers assume responsibility for managing a population of patients, both who are healthy and those who are in need of care. Wellmark offers the ACOs financial rewards if they reach established quality goals and slow the rate of increase in health care spending for these patients. At the same time, providers will not earn their incentives if their quality declines or their costs run higher than expected.

The eight ACOs, representing more than 424,000 members, achieved savings by reducing hospital admissions by nearly 11 percent, readmissions by 8 percent and emergency department visits by 10 percent.

In addition to favorable results for hospital-based savings, preventive care services for participating members increased over the previous year. Notably, in 2014, there were an additional 21,000 more visits to primary care physicians, an additional 2,500 women received mammograms; 1,500 more children received preventive visits and 1,100 more members were screened for colon cancer over the previous year. Also, many of the ACOs improved their continuity of care score, which means members received more coordinated care when needed.

The eight health systems included in the 2014 ACO data include UnityPoint Health, Mercy Medical Center – Des Moines, Genesis Health Systems, The Iowa Clinic, McFarland Clinic, Family Health Care of Siouxland, Wheaton Franciscan Health Care and a collaboration between Mercy Medical Center – Cedar Rapids and University of Iowa Hospitals and Clinics.

Wellmark’s ACOs are comprised of members with fully-insured health insurance plans. Earlier this year, Wellmark established ACO Shared Savings relationships with five additional health systems: Great River Health System, Mercy Iowa City, Nebraska Methodist Jennie Edmundson Hospital, Mercy Medical Center – Mason City, and Pella Regional Health Center.