ACO deal raises health-care hopes

Gazette Editorial Board

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A new partnership between Wellmark Blue Cross and Blue Shield and the Iowa Health System holds promise of controlling costs with a higher quality of care - all while leaving medical decisions in the hands of patients and medical professionals.

We think setups like Wellmark-Iowa's Accountable Care Organization could play a role in solving the complicated problem of spiraling health care costs.

By compensating medical providers based on patient care and outcomes, rather than for specific services, procedures and tests, the ACO agreement calls for reducing unnecessary tests and costly hospitalizations while safeguarding patient health. It aims to shift focus and resources toward helping people stay healthy, rather than waiting for conditions to become acute and more costly to treat.

Getting medical providers and patients on board is key to ensuring the program has a reasonable chance of success.

Wellmark-Iowa announced the partnership late last month, creating Iowa's first commercial health plan Accountable Care Organization.

Twenty-six hospitals, including St. Luke's Hospital in Cedar Rapids, and more than 200 physician clinics in the Iowa Health System will participate in the ACO, which will be rolled out first in Cedar Rapids, Waterloo, Des Moines and Fort Dodge.

In the ACO, providers agree to care for a group of people with varying degrees of health, and to be reimbursed based on quality and cost goals - not simply based how many medical services they provide to those patients. Providers will be compensated for meeting health and wellness benchmarks, and will split the savings with Wellmark when treatments save money without compromising patients' health.

That's a dramatic shift from the traditional fee-for-service system that many say has been a major contributor to runaway health-care costs.

Partners say the new payment system will help providers place more emphasis on prevention, coordination of care, patient engagement and satisfaction. Under the ACO, medical professionals will be compensated for helping patients better manage chronic conditions - such as heart disease and diabetes - that can become life-threatening and require costly medical interventions, if they go unchecked.

The idea may sound familiar, but Wellmark and Iowa Health leaders assure us this is nothing like the mostly disastrous experiment with Health Maintenance Organizations from several years ago. For one, the ACO system is based on incentives, not penalties, for providers to deliver better care at lower cost.

And treatment decisions will remain where they belong - in the hands of patients and medical providers, not insurers.

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