Making the health care delivery system work better for patients at a cost society can afford is an ambitious goal. A new collaboration between the Iowa's largest health care insurer and its most extensive system of hospitals and physicians aims to make progress on both fronts. Fort Dodge's Trinity Regional Medical Center is part of this new arrangement.
Wellmark Blue Cross and Blue Shield of Iowa and Iowa Health System announced late last month a joint effort to create what leaders of the organizations said is Iowa's first commercial health plan Accountable Care Organization. According to a statement released jointly by Wellmark and Iowa Health, the new ACO seeks to coordinate care "to improve quality, provide greater value and slow increases in health care costs."
Transforming the system
Sue Thompson, president and chief executive officer of Trinity Health Systems, said this new initiative is part of a multifaceted effort to transform the way care is delivered. She said the key goals are to enhance the quality of care and improve patient access to needed services while limiting costs in ways consistent with those goals.
Acknowledging that attempts to achieve precisely those results are not new, Bill Leaver, president and chief executive officer of Iowa Health System, stressed during a visit to Fort Dodge Tuesday that the new game plan aims to take advantage of widespread recognition that the health care delivery system must change.
"Our physicians were complaining about their work environment, quite frankly - chasing service volume," he said. "Employers were telling both Wellmark and us, 'It costs too much.' The beneficiaries were saying, 'It's not a great system.'"
Leaver said pervasive dissatisfaction with the status quo makes receptivity to innovation especially high just now.
"I think that the timing and environment are right," he said. "I think there is motivation that maybe wasn't there before. This will be provider-driven with support from the payer. ... We want to put the physician in the driver's seat in terms of taking responsibility for coordinating care and navigating the patient through the system. Helping to drive a better experience. Helping to create quality outcomes and lower costs."
The enthusiasm for the project is high at both Iowa Health and Wellmark, according to representatives of both organizations.
"Our ACO agreement with Iowa Health System is a true collaboration," said John Forsyth, Wellmark chairman and chief executive officer in a statement released April 26. "What makes it different is that the member experience is the focus, while providing incentives, not penalties, to deliver better care at a lower cost."
According to an explanation of the arrangement issued jointly by Iowa Health and Wellmark, the just-created ACO will handle the care "for a group of people, including those who are healthy and those who need care. The insurance company then offers those providers financial rewards if they meet quality and cost goals."
The new ACO will include Iowa Health System hospitals in Cedar Rapids, the Des Moines Area, Fort Dodge and Waterloo.
Better for patients
"We're creating a patient experience that is less confusing and more comforting. Less about illness management and more about keeping people healthy," Leaver said in a prepared statement. "It's a system where physicians lead not only in the care of patients with acute and chronic illnesses, but also with people who are perfectly well and need the tools to stay that way."
According to representatives of Wellmark and Iowa Health, the approach being implemented by the ACO emphasizes keeping people healthy through prevention, coordination of the full range of elements involved in a patient's encounters with the health care system and encouraging patients to be actively involved in their health care.
"Wellmark and Iowa Health System have a long history of working together to improve the quality of care," said Laura Jackson, Wellmark's executive vice president for health care strategy. "We believe the coordination and collaboration between our organizations will help our members stay healthier, avoid unnecessary or duplicative tests, treatments and preventable hospital readmissions, and ultimately reduce the increasing cost of health care."
The ACO being created by Iowa Health and Wellmark will cover patients who are commercially insured by Wellmark. Many large employers self-insure and contract with Wellmark to administer that arrangement. Employees of those self-insured companies will not initially be part of the new ACO arrangement, but may be included in the future as those contracts are renegotiated, according to Wellmark officials.
It was announced in December 2011 that Iowa Health System, Trinity Regional Medical Center and Trimark Physicians Group were selected by the federal government's Centers for Medicare & Medicaid Services to participate in Medicare's Pioneer Accountable Care Organization project. That ACO is similar in concept to the arrangement just announced by Iowa Health and Wellmark for Wellmark's commercially insured population.
"The Wellmark ACO will help to enhance awareness of care coordination for all populations, not just the Medicare population. Wellmark touches a broad group of people - mothers, children, our work force, etc.," Trinity's Thompson said. "This ACO will expand awareness to a broader population."
Thompson said physicians have played a major role in designing both the Medicare ACO and the ACO arrangement with Wellmark. She said they are excited about having the flexibility to make the system work better for their patients.
That point was underlined strongly by Leaver.
"I think (physicians) will see more resources devoted to helping them manage the care. ... Over time, I think we will change the work of the primary care physician so it's less on the episodic - 'I see a patient every 10 minutes' - to 'I'm focusing on the really difficult cases and I have a PA that's focusing on the strep throat.' ... I think that will be a very positive thing for the physicians. ... Their pay, their incentives will be focused on creating value instead of creating volume."
Contact Terrence Dwyer at (515) 573-2141 or email@example.com