Northeast Wisconsin health providers join pilot Medicare program

Posted on Dec 19, 2011 :: Insight on Business, Web Exclusive.
Posted by of Insight Publications

Northeast Wisconsin healthcare providers are playing an integral role in an innovative Medicare pilot program designed to improve health care services.

Bellin Health, ThedaCare and a network of nearly 700 physicians have been picked to be a part of the Center of Medicare Services’ (CMS)  Pioneer Accountable Care Organization. (ACO). Only 32 health care providers in the country were picked to participate, says Dave Krueger, MD, medical director for Bellin Health-ThedaCare Healthcare Partners.

ACOs were part of the Patient Protection & Affordable Care Act, which encouraged their formation as a way to improve the quality of healthcare while slowing the growth of costs. By organizing healthcare teams, technology and knowledge around patient needs, the expectation is that ACOs can achieve better care for Medicare beneficiaries while slowing cost increases.

“The Pioneer ACOs represent our nation’s leaders in health systems innovation, providing highly coordinated care for patients at lower costs,” says Marilyn Tavenner, Acting Administrator of CMS. “Bellin Health-ThedaCare Healthcare Partners has demonstrated significant experience in providing high quality, coordinated care, and we are excited to partner with them,”

“We have a strong history of providing high-quality medical care while also holding down costs. Our collective work is often recognized throughout the country and being chosen to participate in this pilot program is a testament to the quality of care we provide to patients,” Dr. Krueger says. “The goals of the Pioneer ACO are to improve patient care and control the per capita cost of healthcare. To achieve those goals, the doctors and medical staff will need to work together to develop the right tools, personnel, and management competencies across each individual patient’s care needs.”

The ACO model defines a group of individuals – in this case, Medicare patients whose providers have an affiliation with Bellin Health-ThedaCare Healthcare Partners – and part of the payment to the healthcare organization is based on achievement of specific goals including process measures, clinical outcomes and patient satisfaction scores.

The model is designed to work in coordination with private insurance companies and employers with the goal of saving money while improving care quality and outcomes. Since Medicare is the nation’s largest payer of healthcare costs, any changes they make will dramatically impact how healthcare is delivered.

Bellin Health and ThedaCare have a history of working together. They, along with select independent physicians, launched Touchpoint Health Plan in the 1990s. When the health plan was sold, they continued improving healthcare together through the Northeast Wisconsin Health Value Network (NEWHVN). NEWHVN was formed in 2008, bringing together two healthcare systems and independent physicians with the goal of creating value through quality improvement and the efficiency of care provided. The organization recently renamed itself Bellin Health-ThedaCare Healthcare Partners to better represent the parties involved. Bellin Health-ThedaCare Healthcare Partners covers 12 counties in Northeast Wisconsin. Two major healthcare systems: Bellin Health, based in Green Bay, and ThedaCare, based in Appleton, as well as eight major healthcare facilities, and nearly 700 physicians, make up the network.