Wellmark Blue Cross Blue Shield ACO
Successful performance in a shared savings ACO hinges on the proactive, balanced management of three key concepts:
Quality • Cost • Risk
Heartland’s Wellmark ACO continues to demonstrate significant success in all three areas:
Quality: measured using the Wellmark VIS score
In 2016, Heartland ACO practices improved in all quality domains and surpassed the Wellmark VIS target, allowing for shared savings to flow back to the ACO practices
In 2017, Heartland ACO continued surpass the VIS target, exceeding quality goals and allowing access to ACO shared savings for both 2017, as well as guaranteed for 2018
Cost: measured by total savings (per beneficiary per year)
In its first ACO performance year in 2016, Heartland ACO beat the Wellmark Risk-adjusted Cost Target, and achieved a savings of $158.64 per ACO beneficiary, which is able to flow back to the ACO and ACO practices as shared savings.
In 2017, Heartland Rural Physician Alliance Wellmark ACO generated over $720,000 in shared savings in the second year of ACO work, while improving the quality of care for beneficiaries in Heartland practices across Iowa.
Risk: measured through risk adjustment by an increasing ACO Risk Score
In 2016, Heartland’s ACO practices were educated on ACO risk adjustment methodology and coding concepts, and consistently improved their coding efforts, resulting in a steady monthly increase in risk adjustment scoring across the ACO throughout the year.
These efforts and the resulting success in appropriately quantifying the ACO population’s risk have continued consistently throughout 2017, resulting in appropriate benchmarking for the ACO population as shared savings is determined.