ThedaCare ACO and Bellin Health Partners say they’re thrilled to be among 21 networks nationwide participating in a new Medicare payment model.
“This is such an exciting opportunity for us,” said Naomi Wedin, executive director of Bellin Health Partners.
The program, called the Next Generation Accountable Care Organization model, gives more flexibility to the ACOs to implement initiatives such as telemedicine. As with other Medicare ACO programs, the aim is to bring providers and hospitals together to improve patient results, reduce the cost of care and allow ACOs to keep some of the savings. If they don’t do well, however, the ACOs lose money.
ThedaCare and Bellin Health previously partnered in the Fox Valley on Medicare’s earlier Pioneer ACO program, one that had mixed results and saw several participants drop out as it progressed.
But Bellin-ThedaCare Healthcare Partners was among the handful of ACOs that saw huge success, saving Medicare about $3.1 million in 2014 and getting almost $2.2 million of the savings. The ACO also ranked the highest in quality among the 20 ACOs that participated that year.
This year, though, the two are participating separately in Medicare’s new Next Generation ACO model, a move that will help each work with their local markets better. Appleton-based ThedaCare has most of its presence in the Fox Cities, while Bellin Health’s primary coverage area is in Green Bay.
“We started to recognize a growing need in each of our markets for more customized solutions for our large employers and our localized service areas,” said David Krueger, ThedaCare ACO’s executive director and medical director.
ACOs are nothing new in Wisconsin, with several forming to care for patients with private and public insurance following the passage of the Affordable Care Act. This year, 13 Wisconsin-based ACOs will serve almost 135,000 Medicare beneficiaries, according to the Centers for Medicare & Medicaid Services.
That means Wisconsinites in those ACOs will see improved care and savings because “these hospitals and providers have made a commitment to change how they do business,” Sylvia M. Burwell, the secretary of the U.S. Department of Health and Human Services, said this week.
“We are moving Medicare and the entire health care system toward paying providers based on the quality, rather than the quantity of care they give patients,” she said.
There are 477 ACOs nationwide, serving 8.9 million Medicare beneficiaries. The 21 ACOs in the Next Generation model, however, will be able to take on more risk, therefore getting a larger cut of any savings they bring to Medicare.
“We are confident that we will continue to save dollars and we will be on the rewards side of the equation,” Wedin said.
One key difference is that Next Generation ACOs will get in advance the cost targets they have to meet, rather than being compared to national trends at the end of the year.
There are also several flexibilities in the new program, said Krueger, who leads ThedaCare’s ACO and led the previous partnership ACO.
Those include a waiver on a Medicare rule that requires patients to stay in a hospital for three days before going to a skilled nursing facility, as well as a waiver that would boost telehealth services in rural areas.
“By giving us more flexibility, we can create better solutions for patient care to achieve better outcomes, and meanwhile, save money at the same time,” Krueger said.
— By Polo Rocha,
WisBusiness.com
