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Cedar Rapids, Iowa 52401
Wellmark, Iowa Health System prepare rollout of Accountable Care Organization
Cindy Hadish
May. 3, 2012 12:08 pm
Patients should benefit as a new partnership, called an Accountable Care Organization, begins in Iowa with Wellmark Blue Cross and Blue Shield and the Iowa Health System.
Commonly called an ACO, the collaboration is designed to improve quality and lower health care costs between Iowa's largest insurance provider and the health system, which includes St. Luke's Hospital in Cedar Rapids among its 26 hospitals and plus-200 doctor clinics.
“We have to think about health care in a very different way,” Bill Leaver, president and CEO of Iowa Health System, said during a meeting Thursday with The Gazette Editorial Board.
Leaver said the initial rollout of the ACO, under discussion for two years, will be in Cedar Rapids, Waterloo, Des Moines and Fort Dodge.
Laura Jackson, Wellmark Executive Vice President, noted that the concept rewards medical providers for meeting specific quality benchmarks and differs from Health Maintenance Organizations, in which the HMO had to approve all visits, prescriptions and other care in order to be covered.
“Withholding care is not an option,” Jackson said.
Instead, hospitals and clinics will be reimbursed for services and share in savings when those quality measures are met, such as well-child visits, cancer screenings and avoiding hospital readmissions.
Fully insured Wellmark customers will be part of the initial program before self-funded employers join the ACO, Jackson said.
St. Luke's CEO Ted Townsend noted that the hospital already has been providing elements of the ACO with complimentary home visits for new parents and congestive heart failure patients.
Home health staff ensure the heart patients understand and are following medication orders and answer questions as part of those visits, he said.
Primary care doctors will coordinate patient care, but other teams of specialists will be involved to design plans for patients with chronic diseases such as diabetes.
Patients also will have access to a Sioux City call center for questions and more interaction with doctor offices, for example, via email requests for prescription refills.
Leaver said the goal is to keep patients out of hospital emergency rooms and at home.
Townsend said patients will notice only subtle changes as the ACO begins and patient satisfaction will be among the quality measures.
“If we miss the quality targets, we qualify for nothing,” he said. “So quality cannot be sacrificed to get to cost-savings."