On Jan. 1, Trinity Regional Medical Center, Trimark Physicians Group, Berryhill Center for Mental Health and Iowa Health Home Care launched one of the first 32 Medicare Accountable Care Organizations in the United States. We were convinced that by coordinating care between primary care physicians, specialists, nurses and other clinicians at Trinity, Trimark, Berryhill and Home Care we could provide better outcomes for Medicare beneficiaries, help them stay healthier and help reduce the cost of care.
What surprised us was how quickly the ACO has succeeded. In just 11 months, overall inpatient hospital utilization has declined 25 percent, 30-day readmissions have declined 43 percent, frequent emergency department patients are now receiving more consistent care and patient satisfaction scores have improved.
Under our ACO, the Medicare program will pay us on the basis of outcomes, rather than the traditional fee-for-service reimbursements. We must meet or exceed a variety of quality standards such as reduced hospital readmissions. Patient-centered coordinated care is the best way to meet those requirements, improve the patient experience and enhance the efficiency of our health care system.
Alignment and infrastructure
The Iowa Health System model starts with the vision of delivering the best outcome for every patient every time. Primary care physicians, specialists, affiliated hospitals and home health all are aligned so all the providers treating a patient coordinate their care whether it is delivered at the clinic, hospital or at home. The system recognizes that because of the long-standing affiliation of Trinity and Trimark, we were one of few organizations in the nation that had the capability to operate an ACO. Iowa Health System also had the foresight to build an infrastructure including a shared information technology system that allows for greater coordination among all of our provider partners.
The Trinity and Trimark teams rely heavily on electronic medical records and Medicare claims histories of our patient populations. Iowa Health System has provided us with best-in-class analytical capabilities so that we can identify patients with chronic conditions and work with them to better manage conditions such as diabetes, chronic obstructive pulmonary disorder (COPD) or congestive heart failure. The data helps us to identify the best practices in treating illnesses and improve patient outcomes.
Innovative care delivery
The patient data also are put to use in a variety of programs coordinated care programs that help patients recover and stay healthier regardless of where they receive care. These include:
An Advanced Medical Team that aligns clinical and community resources for patients suffering from serious chronic diseases. The program's initial focus has been COPD patients, many of whom also suffer from other chronic diseases such as diabetes or congestive heart failure. The team includes a care navigator who contacts each patient regularly either face to face or by telephone to make sure they are following their care plan. If needed, the care navigator can arrange transportation for patients to see their primary care physicians or therapists or find ways to help patients obtain suitable medications at a price they can afford.
Care at home
Care at home is another effort to help patients remain in their homes discharged from the hospital to avoid complications that can lead to readmissions or Emergency Room visits. Post care coordinators visit patients within 48 hours of discharge and follow up with them weekly to assure they are adhering to their care plan, taking their medications as prescribed, and making dietary and other lifestyle changes to recover and stay healthier.
A palliative care program provides specialized medical care for patients living with serious or life-threatening conditions such as: cancer, heart failure, kidney disease, lung disease, dementia, etc. Palliative care provides relief from distressing symptoms and helps improve quality of life for patients and their families.
We were able to develop these initiatives because the staff across all care settings broke down the traditional silos that have fractionalized health care delivery in the U.S. for more than 50 years with a program called "One Team." It energized the entire staff to take on a new way of delivering health care that focuses on value and outcome, rather than volume of care. It paved the way for people who had worked in our facilities for years and who didn't know one another to now work together coordinating the care they provide our patients.
Since starting our ACO in January, Iowa Health System has created others. Advanced Medical Teams are being established across the Iowa Health System. Medicare Shared Savings Programs which operate much like our ACO are serving patients at Iowa Health System facilities in Cedar Rapids, Des Moines and Waterloo, and in the Quad Cities of Iowa and Illinois. And we have teamed up with Wellmark Blue Cross and Blue Shield to establish an ACO to serve Wellmark members here in Fort Dodge, Cedar Rapids, Des Moines and Waterloo. Together, the ACOs serve more than 209,000 patients.
This work has put Fort Dodge at the epicenter of health care transformation in the United States. It also establishes Trinity-Trimark as a laboratory for the rest of Iowa Health System to develop innovative programs to deliver the best outcome for every patient every time.
Sue Thompson, president and chief executive officer of Trinity Health Systems.