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.”

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Depression, race, opportunity for health, explorer Bancroft all at upcoming conference

Where can you find conversations about mental health, equal opportunity for health and using data in exploration and more all in one place? At the MN Community Measurement Annual Conference. Join the conversations 8:15 to 5 p.m., Sept. 15, at the Earle Brown Heritage Center in Brooklyn Center.
Ann Bancroft, one of the world’s preeminent polar explorers and internationally recognized leader, will start the day off with her stories of discovery, pioneering, exploration and using measurement and data to help her and others navigate expeditions.
In the afternoon, Stephen Nelson, M.D, director of the Sickle Cell Clinic at Children’s of Minnesota, will speak about race, racism and how we can all give Minnesotans the opportunity for health and well-being.
Topics throughout the day include adolescent depression and mental health, medical expenses and what we can do to improve the care Minnesotans get.
Find out more and register at MN Community Measurement.

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Patients rate knee, back surgeries

Thousands of Minnesotans have surgeries on their knees and back. How do they feel after the surgery compared to before? MN Community Measurement asked. Here’s what patients reported.

The details are here and you’ll see the amount of improvement varies by where the patient went for surgery.

Minnesota is the first state in the nation to collect and publicly release results for three orthopedic surgeries: total knee replacement and back surgeries. Back surgeries in this report are lumbar fusion, which joins vertebrae in the lower back so they heal into a single bone, and herniated disc, removing all or part of the damaged disc that is causing problems.
Note when you look at the report, the back surgeries rated on a 100-point scale, measure how much pain, function and mobility improved. The knee surgery rating is a 48-point scale; the higher the score the better the knee worked.

“It is important to understand the effectiveness of these surgeries because the demand for them is growing.” – Ed Ehlinger, M.D., commissioner, Minnesota department of health

Detailed information on each type of surgery is available here. And you can find out more from the Minnesota Department of Health.

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Minnesota’s clinics rated in Consumer Reports magazine

In the May issue of Consumer Reports, a special insert includes ratings on 500 primary care clinics across the state. The ratings, which reflect the same data as what is currently on MNHealthScores.org, provide Minnesotans with objective information on the quality of care for colon cancer screening, diabetes care and vascular care. Clinics were included in the insert if they had enough data to report on at least two of the three measure areas.

These ratings give Minnesotans a window into how their doctors compare. Known as the Doctor Project, the effort was funded by the Robert Wood Johnson Foundation and was led in Minnesota by our colleagues at MN Community Measurement.

 

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Minnesota earned an A; congrats

Not a regular reader of Forbes magazine? Neither am I. So I missed this cool article that reported on information to help us understand if we’re getting excellent care. First the bad news: 43 states flunked. But the good news is Minnesota is one of three states (along with California and Washington) to earn an A.

“The vast majority of Americans simply don’t have access to local information on the quality of physician care,” the story states. It also notes our efforts here in Minnesota are increasingly looked at as a model because Minnesota HealthScores is a statewide effort to compare clinics on the success of the care and treatment, along with how people feel about their experience at the clinic.

Minnesota’s work, through MN Community Measurement, is unique because the information isn’t just one health insurance company’s ranking, the data to create the reports come directly from the clinics for the most part.

Read the original Forbes article.

-Eileen Smith

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UCare recognizes clinics, care systems for outstanding results

Nineteen clinics and care systems were recently rewarded by UCare for achieving goals in the health plans’ 2014 Pay for Performance (P4P) and quality improvement programs. The clinics received more than $2.5 million in financial incentives. In addition, awards went to two systems for going the extra mile to deliver culturally responsible health services, and reduce barriers to care for people with disabilities. UCare logo

The P4P awards recognize health care providers who earned quality excellence awards for improving care for more than 500,000 UCare Medicare, MinnesotaCare, Medical Assistance and other members in Minnesota and western Wisconsin. UCare analyzes patient care claims to determine P4P reward recipients.

The Excellence in Culturally Competent Care Award went to CentraCare Family Health Center for making significant changes to improve culturally appropriate care and communication with patients from other cultures. The University of Minnesota Community-University Health Care Center (CUHCC) received the Excellence in Disability Care Award for making significant changes to remove barriers to care for people with physical disabilities and mental illness, and helping UCare members access preventive services.

Physicians and staff from nine clinics were recognized for their overall quality of care for seniors in Medicare, and the state’s program that combines Medicare and Medical Assistance.

MSHO Overall Performance Quality of Care honorees were:

Medicaid Overall Performance Quality of Care were:

“UCare strives to deliver quality in all aspects of our health coverage plans and services to members,” said Dr. Russ Kuzel, senior vice president and chief medical officer. “We are proud to recognize and honor high-performing providers who share our commitment to helping UCare members achieve and maintain optimal health at all stages and ages of life.”

UCare’s P4P criteria are selected to improve preventive care. UCare evaluates efforts to identify health issues and risks through screenings for various health risks and conditions such as high cholesterol among members with diabetes and cardiovascular disease, as well as breast cancer screenings and management of antidepressant medications. UCare also uses criteria tied to well-child visits and the monitoring of nephropathy in members with diabetes. Measures are based on specifications from the Minnesota Department of Human Services, Minnesota Department of Health, the Healthcare Effectiveness Data and Information Set, the Institute for Clinical Systems Improvement, and MN Community Measurement.

 

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