Wellmark Accountable Care Organizations

Program Location:

Des Moines, IA

Payer Type:

Commercial

Parent Program:

Blue Cross Blue Shield Value-Based Care Program

Payers:

Wellmark (Blue Cross Blue Shield Iowa & South Dakota)

Reported Outcomes

Description:

Wellmark is collaborating with thirteen health systems in an ACO payment system focused on improving the health care experience and slowing the rate in health care cost increases. The ACO arrangements were created to keep healthy people well and improve outcomes for our members when they need care.

The Goals of Wellmark's ACO Strategy

Wellmark's ACO strategy will enhance Wellmark members' care in a variety of ways:

Quality outcomes. Keep healthy people well and improve the outcomes for Wellmark members when they need care.
Better experience/more informed patient. Ensure all appropriate care is received in a timely manner and that patients are actively engaged in the care they receive and understand the costs.
Reduce the rate of increase. Wellmark will support participating providers' efforts in lowering costs without compromising care. In addition, Wellmark will share any cost savings with the ACOs.

The Focus of our ACO Strategy

The focus of an ACO arrangement is a gradual and subtle improvement in the attention and care people receive from their health care provider, such as:

Prevention: Proactive outreach to ensure that healthy people remain healthy by obtaining regular exams and immunizations, and by 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.

Program Website

Related News & Resources

Payment Model:

Wellmark will share any cost savings with the ACOs. Payments are linked to quality improvements that also reduce the rate of increase in health care costs to incentivize providers to deliver better care more efficiently. There are no incentives to withhold medically necessary care.

Fewer ED / Hospital Visits:

Wellmark Press Release (September 2015)_{based on a review of 2014 claims data}

The 8 ACOs, representing more than 424,000 members, achieved savings by:
- reducing hospital admissions by nearly 11%
- reducing readmissions by 8%
- reducing emergency department visits by 10%

Wellmark Press Release (August 2014)

The 5 initial ACOs participating in 2013 achieved savings through:
- reducing hospital admissions by nearly 12%
- readmissions by 7%
- and ED visits by nearly 11%

Improved Health:

Wellmark Press Release (August 2014)

The 5 initial ACOs participating in the shared savings agreement improved thier quality scores by over 35% in the first 2 years

Improved Access:

Wellmark Press Release (September 2015)_{based on a review of 2014 claims data}

In 2014, among participating ACO members, there were an additional 21,000 more visits to primary care physicians
In 2014, many of the ACOs improved their continuity of care score, which means members received more coordinated care when needed.

Cost Savings:

Wellmark Press Release (September 2015)_{based on a review of 2014 claims data}

8 of the 13 participating ACOs improved their overall quality scores by 8% and saved more than $17 million during 2014

Wellmark Press Release (August 2014)

The 5 initial ACOs participating in the shared savings agreement saved more than $12 million during the first two years. As a result, each of these 5 participating ACOs recieved incentive payments from Wellmark for achieving their performance goals

Increased Preventive Services:

Wellmark Press Release (September 2015)_{based on a review of 2014 claims data}