Iowa ACO launched in partnership between insurer and integrated health system

Agreement designed to enhance patient experience and slow cost increases

April 26, 2012
DES MOINES, Iowa (April 26, 2012) – Today, Wellmark Blue Cross and Blue Shield of Iowa announced a groundbreaking collaboration with Iowa Health System that creates Iowa’s first commercial health plan Accountable Care Organization (ACO). The new ACO focuses on coordinating care to improve quality, provide greater value, and slow increases in health care costs.

In an ACO, providers take on responsibility 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. At the same time, providers will lose their financial incentive if their quality declines and their costs run higher than expected.

John Forsyth, Wellmark chairman and CEO said, “Our ACO agreement with Iowa Health System is a true collaboration. 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.”

The ACO includes the following Iowa Health System hospitals, their affiliated medical clinics, and home health care services: St. Luke’s Hospital in Cedar Rapids; Iowa Health-Des Moines, including Iowa Methodist Medical Center, Iowa Lutheran Hospital, and Blank Children’s Hospital in Des Moines and Methodist West Hospital in West Des Moines; Trinity Regional Medical Center in Fort Dodge, and Allen Memorial Hospital in Waterloo.

“We’re creating a patient experience that is less confusing and more comforting. Less about illness management and more about keeping people healthy,” says Bill Leaver, president and CEO of Iowa Health System. “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.”

Wellmark members who see an Iowa Health System provider who is part of the ACO will continue to receive high quality patient care. Patients will also experience attention and care which includes:

Prevention: Proactive outreach to ensure that healthy people remain healthy by obtaining regular exams and immunizations and participating in preventive programs.

Care Coordination: Seamless patient experience when setting an appointment, seeing multiple doctors, and receiving follow-up care.

Patient Engagement: Providers encouraging patients and their caregivers to take an active role 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.”

“These agreements represent a transformation of health care from a reimbursement system that has emphasized quantity of care to one that rewards quality of care,” adds Kevin Vermeer, executive vice president and chief financial officer, Iowa Health System. “We choose to lead this change because it’s the right thing for our patients.”

About Wellmark

Wellmark, Inc. (www.Wellmark.com ) does business as Wellmark Blue Cross and Blue Shield of Iowa. Wellmark and its subsidiaries and affiliated companies, including Wellmark Blue Cross and Blue Shield of South Dakota and Wellmark Health Plan of Iowa, Inc., insure or pay health benefit claims for more than 2 million members in Iowa and South Dakota. Wellmark Blue Cross and Blue Shield of Iowa, Wellmark Blue Cross and Blue Shield of South Dakota, and Wellmark Health Plan of Iowa, Inc. are independent licensees of the Blue Cross and Blue Shield Association.

About Iowa Health System

IHS has relationships with 26 hospitals in metropolitan and rural communities and more than 200 physician clinics. With annual revenues of $2.8 billion, IHS entities provide patient care in Illinois and Iowa and employ greater than 24,000 employees.

IHS has organized Integrated Delivery Systems (IDS’s) in the communities served. These IDS’s consist of aligned physicians and other providers in the regions including these hospitals: Iowa Health-Des Moines (Iowa Methodist Medical Center, Blank Children’s Hospital, Iowa Lutheran Hospital, and Methodist West Hospital); Allen Memorial Hospital (Waterloo, Iowa); The Finley Hospital (Dubuque, Iowa); St. Luke’s Regional Medical Center (Sioux City, Iowa); St. Luke’s Methodist Hospital (Cedar Rapids, Iowa); Trinity Regional Medical Center (Fort Dodge, Iowa); Trinity Medical Center (Rock Island, Illinois); and The Methodist Medical Center of Illinois (Peoria, Illinois), and Iowa Physicians Clinic Medical Foundation doing business as Iowa Health Physicians and Clinics.

Over the years, IHS hospitals have received national recognition for quality, service and patient satisfaction, including the Magnet Award for Nursing Excellence, Top 100 Heart Hospital designation, HealthGrades Patient Safety Award, Gold Iowa Recognition for Performance Excellence, and more. IHS entities also include four accredited colleges of nursing and/or allied health fields and approximately 800 employed physicians.

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