Wellmark ACOs generate $35M in health savings
BPC Staff Jul 27, 2016 | 8:27 pm
2 min read time
423 wordsAll Latest News, Health and Wellness, InsuranceAccountable care organizations in Iowa that are working with Wellmark Blue Cross Blue Shield last year realized a total of $35 million in health care cost savings, which averages out to $200 per policyholder, Wellmark officials announced Tuesday.
The 13 health systems participating in the ACOs achieved savings by reducing hospital readmissions by more than 22 percent, inpatient admissions by almost 8 percent and emergency department visits by nearly 4 percent, according to Wellmark.
The ACOs include more than 179,000 fully insured Wellmark members in Iowa. Next year, self-funded Wellmark customers will be offered the opportunity to have their employees be included in the ACO’s population of members.
The cost savings in 2015 were more than double the $17 million in savings that Wellmark reported a year ago for 2014, when eight health systems were participating in the shared savings model.
“Wellmark’s ACO shared savings results demonstrate that managing the health of a population is working — in fact, our ACOs continue to produce results annually, with some organizations now in their fifth year of participation,” said Mike Fay, vice president of health networks for Wellmark. “We are pleased and encouraged by the 2015 results.”
Under the accountable care organization model, health care systems are rewarded by insurers for improving quality of care and effectively managing costs. The health care providers assume responsibility for managing a population of patients, both those who are healthy and those who are in need of care.
Wellmark offers the ACOs financial rewards if they reach established quality goals and slow the rate of increase in health care spending for their patients. At the same time, providers will not earn their incentives if their quality declines or their costs run higher than expected.
In addition to the cost savings in 2015, quality of care also improved as a result of an increase in preventive care services for participating members. Notable increases include:
- 13,254 additional members visited a primary care physician (4 percent increase).
- 995 more women received mammograms (2 percent increase).
- 763 additional children received well-child visits (6 percent increase).
- 243 more members were screened for colon cancer (2 percent increase).
The 13 health systems included in the 2015 ACO data are: Family Healthcare of Siouxland, Genesis Health Systems, Great River Health System, McFarland Clinic, Mercy Iowa City, Mercy Medical Center-Des Moines, Mercy Medical Center-Mason City, Nebraska Methodist Jennie Edmundson Hospital, Pella Regional Health Center, the Iowa Clinic, UnityPoint Health, Wheaton Franciscan Healthcare and a collaboration between Mercy Medical Center-Cedar Rapids and University of Iowa Hospitals and Clinics.
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