ACOs build toward the future

What happens when you realize doctors and insurers, patients and employers are all on the same side? Great care that’s less expensive.

 

Read how an ACO pioneer is reinventing care for Minnesotans.

 

Taking health care personally
When you ask an insurance company vice president about the benefits of accountable care organizations, or ACOs, you expect to hear talking points and impressive figures. But Christine Finn, vice president of sales communications at Medica, says something unexpected. “I belong to an ACO,” she says. “When I go to the doctor, all my records are in one place — I don’t have to say the same thing over and over.” If you’ve ever filled out the same form in a new doctor’s office for the umpteenth time — and chances are you have — you’ll understand why simply not repeating yourself makes such a huge difference.

Chris Finn, Medica

Ken Horstman, University of Minnesota

Lisa Span, Medica

 

Chris has responsibility for sales communications at Medica, but she talks about her ACO from a patient’s perspective. That’s as it should be, she explains. “The accountability in ‘accountable care’ is something we take personally,” says Chris. “Medica, with our health care provider partners, takes accountability for driving improvements in health care that affect our members. Including me.”

Today, nearly 50,000 receive their health care through one of six ACO networks and eight leading health systems — Altru, Essentia Health, HealthEast, Fairview, Mayo Clinic Health System, North Memorial, Park Nicollet and Ridgeview Community Network.

 

Starting from common ground
The basic principles of accountable care organizations, like Medica’s, are easy to understand. First, ACOs assume that insurers, employers, medical professionals and patients can and do want to achieve better medical results at lower prices. With that fundamental agreement in mind, ACOs set up payment structures that reward quality and efficient care — then pass any resulting savings on to everybody involved.
“Medica was the first health plan in the region to align with a health system to develop an ACO,” says Chris. Back in 2012, Medica’s partnership with Fairview Health Services was innovative and market-leading. Medica’s partnership with Fairview was so successful that the insurer decided to double down on the collaborative model.
“By now,” Chris says, “we’ve had ACOs in place long enough to prove they’re delivering meaningful improvements.” Members enrolled in ACOs average:

  • a 12 percent increase in the use of preventative services
  • nearly 14 percent fewer ER visits
  • 16 percent fewer hospital admissions
  • increased use of affordable generic medications

“We’re not just giving lip service to efficiency. With our ACO partners, we’re keeping people healthier, for less.” How much less?

 

Employers who choose ACOs are spending up to 15 percent less than they would with broad-network plans and employees enroll year-after-year. That’s how ACOs quickly became one of Medica’s most popular health insurance options.

 

Better care for less
Better care for less sounded like a very good bargain to large employers, for whom health insurance is a massive and growing expense. The University of Minnesota, one of the best research institutions in the nation and the world, is also the state’s sixth-largest employer.

 

“When ACOs came along a few years ago, we saw them as a way to address care and cost all in one package,” says Ken Horstman, the university’s senior director for total compensation.

 

But the ACO model could be a challenge for University employees to accept. Like many other Minnesotans, U of M employees had been accustomed to “open-access” policies, which let them see any doctor or hospital they preferred, and enrolling in an ACO plan would mean choosing from a smaller selection of in-network care providers. “We did not know what the first-year experience would be,” Ken says, “but 95 percent of the employees who chose the ACO plan stayed in it the next year.”
Employees liked it, and the University did too. “After the first year,” Ken recalls, “we looked at the utilization experience, risk reduction and average medical cost for employees and families who’d switched into an ACO and compared it with their experience from the year before, under a broad-network plan. The same employees, on average, had lower costs with the ACO.”

 

With results like those, Ken and his colleagues decided to encourage even more university employees to join ACOs. “We’ve made a commitment that we’re going to support more of the overall premium for our employees who choose ACO plans,” he says, “in the belief that members’ experience with the ACO will continue to be positive and that their overall health will be supported.” This year, about 15 percent of the 38,000 people insured through the University are enrolled in ACO networks, and Ken anticipates that more will make the leap as time goes by.

 

Like Chris Finn, Ken knows the benefits of ACOs from personal experience. “I took my family into the ACO this year,” he says. “I got a call from my clinic and from an ACO representative to encourage us to stay in touch if we had questions. My son got a call from them saying that they’d noticed a gap in care for his asthma, and offered to help him get that taken care of.” Before joining the ACO, Ken observes with delight, “the only time we ever got a call from a clinic ever at our house, it was from our dog’s vet! This was the first time I’d ever received a call from a medical provider without asking for it.”

 

The benefits of partnership
Why are Medica’s ACO partnerships working so well? Better health care happens when you start from the assumption that everybody — employees and their employers, doctors and nurses, hospitals and insurers — is on the side of wellbeing. For insurers and health care providers, traditionally at odds, that shift to agreement has been particularly fruitful.
“I love this work because we’re coming at it with a new mentality,” says Lisa Spann, Medica’s director of market and product efficiencies. “We’re not going into it with our traditional mindset. Instead of looking at health care from an insurer’s perspective, we sit down together with providers. By having these conversations together, the dialogue shifts. We start asking, ‘How would our members experience this? What really matters to them?’ The ACO is more than just a new model for reimbursing providers,” she adds. “It enables real creativity.”

 

Lisa’s work brings her into contact with Medica’s six ACO partners every day, so she understands the difficulties — and the rewards — of crossing old institutional boundaries to put wellbeing first. When she thinks about the future of health care in Minnesota and beyond, she sees challenges. “There’s a long way to go,” Lisa admits. “But we’re tackling the first step. We’re creating infrastructure between payer and provider, and establishing real trust. Once we’ve got that, we can tackle any problem.”