Three health groups have partnered to create a new organization that will focus on coordinating patient care.
Wellmark Blue Cross and Blue Shield of Iowa is working with Mercy Medical Center in Cedar Rapids and the University of Iowa Hospitals and Clinics to create a new accountable care organization to improve quality in patient care and slow cost increases.
In an ACO, providers assume responsibility for managing a population of patients — both those who are healthy and those who are in need of care — no matter where in the system the patients receive care, according to a news release. Wellmark offers the providers 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 financial incentive if their quality declines or their costs run higher than expected.
The quality goals are for primary care physicians, said Sheryl Terlouw, director of network innovation at Wellmark. Using a tool called the quality index score, areas that include wellness services and chronic care are measured. The result is a composite score, Terlouw said.
The goal of the ACO is to “bring together players to enhance care coordination,” said Courtney Greene, Wellmark spokeswoman.
Right now, there is little financial incentive to keep people healthy and out of the health care system, Greene said.
“The health care system has operated much the same way since the Great Depression,” she said.
“People get sick and go to the doctor’s office. Doctors treat patients for what ails them and the doctors are paid based on the services they provide.”
The system is fragmented, she said. In the current model, health care providers are paid for each service they provide. Under an ACO, providers are paid for “the value of delivering the right care rather than the most care.”
“The success of health care reform depends on transforming into more efficient and collaborative health care systems and assisting patients with establishing a ‘medical home,’” said Timothy Charles, president and CEO of MercyCare Service Corp. and Mercy Medical Center in Cedar Rapids.
Wellmark now has five ACOs in Iowa, including with Wheaton Franciscan Healthcare in Waterloo and with UnityPoint Health in Des Moines.