Published on June 08, 2012

Wellmark and Genesis Enter Into Accountable Care Organization

Genesis is first ACO in QC

Wellmark Blue Cross and Blue Shield of Iowa has announced a collaboration with Genesis Health System in Davenport to create an Accountable Care Organization (ACO).

The new ACO will focus on coordinating patient care to improve quality, provide greater value, and slow increases in health care costs.

Genesis Health System President and CEO, Doug Cropper, said he looks forward to seeing improvements in the quality and reductions in the cost of care.

“This collaboration is the next important step of a process that began for Genesis two years ago when we made the commitment to participate in the transformation of health care,” Cropper said. “Wellmark and Genesis have a long, shared collaboration of serving our customers and patients with a high quality of care and a high level of efficiency.”

Improving quality

In an ACO, providers assume responsibility for managing a population of patients, both who are healthy and those in need of care, no matter where in the system the patients receive care.

Wellmark offers the providers financial rewards if they reach established quality goals and slow the rate in increase in health care spending in caring 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.

John Forsyth, Wellmark chairman and CEO said, “Wellmark is pleased to enter into this ACO agreement with Genesis Health System, to improve the health care experience, and to help slow the rate of cost increases. This ACO was created to keep healthy people well and improve outcomes for our members when they need care.”

The ACO will enhance Wellmark members’ care in a variety of ways:

• Providers encouraging their patients to take an active role in their health care.
• Continued freedom to see the doctors of their choice.
• Seamless customer experience when setting up an appointment, seeing multiple doctors, and receiving follow-up care.
• A reduction of redundant care and services.

“This has been an extensive and rewarding process,” said William Langley, M.D., executive director of the Genesis Accountable Care Organization. “Since Genesis made the commitment to form an ACO two years ago, we have advanced to the point that it’s now a reality. We are looking forward to collaborating with Wellmark to keep the population we serve healthy.”

Coordinating care

The new ACO is reflective of efforts already underway at Genesis to improve coordination of care throughout the health system. That will mean changing infrastructure, processes and information systems and finding ways to ensure all parts of the health system work together, rather than in isolated centers of excellence.

Across the nation, health care has long benefited from advanced technology and highly-trained health care professionals, Dr. Langley said. What has been lacking, however, is coordination of care to best meet the needs of patients. An example: A patient receives a heart procedure at the hospital, but no one alerts him to the fact he’s also long overdue for a colonoscopy.

“Genesis has been part of this movement to better coordinate care...rather than focus on the disease or the health care concern that’s most urgent,” Dr. Langley said. “As a result, our efforts have put us in a better position to enter into relationships with payors--insurance companies or employers.”

Ultimately, that’s very good news for Genesis patients, he said.

Whether they’re visiting the Emergency Department, having a surgical procedure, receiving a visit from a home health nurse or seeing their family doctor, the goal is to bring them coordinated care and connect them to where they should receive care next.

While that has always been the goal, advanced electronic medical information systems that bring the patients’ health records to all points of care are helping make it a reality.

Meanwhile, an essential part of Genesis’ coordinated care efforts will be “Patient- Centered Medical Homes,” a care model intended to provide effective, efficient coordinated clinical care using a physician-led team approach. This model, being piloted in five Genesis Health Group primary care offices, uses care teams to manage patients’ wellness, preventative and chronic care needs. The aim is to deliver care earlier and more affordably to prevent illness and hospital re-admissions.

While it’s not a new approach, it’s one that is gaining popularity as government mandates force health care providers and private payors to find ways to reduce the cost of care.

This time of major change in health care is exciting for Dr. Langley, who like many of his family medicine colleagues has worked to coordinate care for his patients over the years when they needed to see a specialist, undergo a test or procedure, or enter the hospital.

“We have excellent health care in every aspect, but it’s not always connected,” Dr. Langley said. “Our goal as a health system over the next five years is to have better coordination of care. Coinciding with this is the national movement among payors and employers to hold providers of care more accountable.”

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