ACOs – The Most Important Health Care Reform You Have Never Heard Of

By Doug Cropper President and CEO Genesis Health System

The issues driving health care reform have thus far survived a Supreme Court ruling and a presidential election.

New models for health care are in our future, and I believe there are benefits to patients as health care providers work together to create healthier communities.

Genesis Health System and other hospitals, health systems and health insurers across the country are creating and implementing Accountable Care Organizations (ACOs), which will be accountable for the overall quality, cost and care of patients.

The guidelines for establishing Accountable Care Organizations were proposed as part of the Patient Protection and Affordable Care Act. Health care providers and health insurers did not wait for the Supreme Court, the recent election, nor any further action from Congress. They have introduced ACOs on their own within the framework set by the Affordable Care Act.

The Genesis Health System ACO has announced ACO relationships with Wellmark Blue Cross and with Medicare. Genesis is also one of four members of the University of Iowa Health Alliance, which has created the largest health care organization in Iowa with 20 hospitals and nearly 2,000 physicians to position us to be more successful as an ACO.

The members of the University of Iowa Health Alliance are working together to advance the high quality of health care services and to improve the health status of patients and communities. The alliance creates an organization for the partners to share expertise, selected support services and information technologies.

What will Genesis patients notice from the Genesis ACO relationships? We hope, they'll notice a lot of benefits.

  • Safety and quality: Patient safety and quality are important areas of focus of ACOs. ACOs will benefit financially by providing the best possible care for each patient and will be penalized financially when patient care falls short of high standards. Genesis has made strides toward enhancing quality of care and patient safety. In the measurements of quality surveyed by the Centers for Medicare and Medicaid, Genesis consistently ranks above national averages and is near the top in some of the quality measures. Genesis Medical Center, Davenport and Genesis Medical Center, Silvis Campus both have received A grades from Hospital Safety Score. Genesis has been recognized for quality and efficiency as a Top 50 Health System nationally and a Top 50 Cardiovascular Hospital. Genesis is also a Magnet hospital, which recognizes the highest standards of quality in nursing excellence. And, when it comes to patient satisfaction, the Genesis Heart Surgery program and the emergency department at Genesis Medical Center, DeWitt have been named repeat winners of the Summit Award.
  • Integrated care: Your medical records will be available throughout the Genesis ACO. Health providers will have access to your secured medical history, giving them information about your health to provide the best, most efficient care. If you are referred to a specialist within the Genesis ACO, the specialist will also have access to your secured health history. When you need a prescription, it will be written electronically by the doctor's office and will likely be waiting for you at your preferred pharmacy moments later. One of the key elements in implementing an ACO model is to have strong relationships and collaboration with physicians to be able to offer a continuum of care for our Medicare patients. Genesis is very well aligned with primary care physicians and specialists and the Genesis network of health care providers will be expanding. Genesis already has the technical infrastructure in place to provide seamless care for patients. Genesis is the only Iowa health system or hospital to be recognized for nine consecutive years as one of the nation's 100 Most Wired. Genesis is an early adopter of the Iowa Health Information Network to share information with University of Iowa Hospitals and Clinics and other major Iowa hospital centers.
  • Patient health support: The Genesis ACO is adding health coaches and navigators in Genesis Health Group offices. By the end of 2013, all Genesis Health Group offices will have at least one nurse (RN) available as a health coach to monitor the health of patients, particularly those with chronic illnesses, such as diabetes and chronic obstructive pulmonary disease (COPD). The health coach in your primary care physician's office may contact you about how your care is going, what are your blood sugars, have you gotten some exercise, have you completed the recommended prevention care? The concept is to maintain and monitor the health of patients with chronic illness before their condition requires hospitalization.
  • Community health: We all understand that Americans need to be healthier. Facts regarding the declining health of Americans, such as obesity rates are shocking. If health in America improves, total health care costs will at least be stabilized. Genesis has actually been able to lower its own employee health costs through an approach that includes annual screening, healthy lifestyle programs, and prevention of wellness initiatives. Similarly, ACOs benefit if the populations they care for are healthier and, of course, patients also benefit. You will see more screenings and more prevention and wellness initiatives.

Reimbursements of ACOs will be based on quality of care, patient outcomes and efficiency instead of volumes. Organizations will be rewarded for controlling costs, meeting quality benchmarks and working with the public on prevention and management of chronic diseases. ACOs will benefit by keeping patients healthy and out of the hospital.

One of the questions I answer most often about ACOs is, "how are ACOs different than the HMO model of the 90s?'' My response is that they are radically different. Here is how they differ:

ACOs are a health provider delivery model. In an ACO, providers collaborate together to focus on coordinating care across all delivery sites in order to provide the best patient care.

ACOs focus on making the population healthier, but when care is needed, it will be provided at the highest quality possible in the most cost effective manner at the most cost effective location. That doesn’t mean withholding care, it means providing better care at a lower cost.

There are incentives, not penalties for providers to deliver better care at a lower cost. These incentives focus on the total cost of care, not just an individual component such as hospital cost, physician cost or surgical cost.

Lastly, HMOs were primarily an insurance delivery strategy to radically discount payments to providers and restrict access to care. Again ACOs reward providers for providing quality care at a lower total cost. ACOs are an open model that does not restrict access.

Genesis and many other health care organizations across the country are moving ahead with reform. We're moving ahead because it is the right thing for our community, the right thing for health care providers and the right thing for the country.

I believe you'll see the benefits as health care is transformed in the Quad Cities and nationally.