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July 26, 2016

DES MOINES, Iowa — Many Iowans are receiving better health care at a lower cost according to Wellmark Blue Cross and Blue Shield’s 2015 Accountable Care Organization (ACO) Shared Savings performance results released today.

Thirteen participating provider organizations that engaged in ACO contracts with Wellmark have improved their overall quality scores by more than 4 percent and achieved savings that equal almost $200 per member per year or $35 million in total. The ACO relationship between Wellmark and health care providers is a collaboration that puts the patient at the center of the health care system and uses data to identify and improve the way patients receive care. The 13 ACOs are accountable for more than 179,000 fully insured Wellmark members. In 2017, self-funded customers will be offered the opportunity to have their employees be included in the ACO’s population of members.

The ACOs achieved savings by reducing hospital readmissions by more than 22 percent, inpatient admissions by almost 8 percent, and emergency department visits by nearly 4 percent.

“Wellmark’s ACO shared savings results demonstrate that managing the health of a population is working — in fact, our ACOs continue to produce results annually with some organizations now in their fifth year of participation,” said Mike Fay, vice president, health networks. “We are pleased and encouraged by the 2015 results.”

ACOs are designed to improve the quality of patient care and slow increases in health care costs ultimately providing greater value to the population they serve. Providers in an ACO contract assume responsibility for managing a population of members, both those who are healthy and those in need of care. Wellmark offers the providers financial rewards if they reach established goals. At the same time, ACOs are at risk of not earning their rewards, and even having to refund money, if their quality declines or their costs run higher than expected.

In addition to the cost savings in 2015, quality of care also improved due to an increase in preventive care services for participating members. Notable increases include:

  • 13,254 additional members visited a primary care physician (4 percent increase)
  • 995 more women received mammograms (2 percent increase)
  • 763 additional children received well-child visits (6 percent increase)
  • 243 more members were screened for colon cancer (2 percent increase)

Also, many of the providers improved their continuity of care score. This means they were able to improve Wellmark members’ experience through seamless navigation of the health care system. This includes coordinating and scheduling multiple appointments with various health care providers, ensuring proper health information was shared and following up with the member by answering questions and providing reminders.

The 13 health systems included in the 2015 ACO data include: Family Healthcare of Siouxland, Genesis Health Systems, Great River Health System, McFarland Clinic, Mercy Iowa City, Mercy Medical Center – Des Moines, Mercy Medical Center – Mason City, Nebraska Methodist Jennie Edmundson Hospital, Pella Regional Health Center, The Iowa Clinic, UnityPoint Health, Wheaton Franciscan Healthcare and a collaboration between Mercy Medical Center – Cedar Rapids and University of Iowa Hospitals and Clinics.