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Friday, September 19, 2014

MaryBeth Matzek: Bellin-ThedaCare tops in national Medicare program

Dave Krueger sees Bellin-ThedaCare Healthcare Partners’ success at providing high quality care while keeping costs in line as a potential game changer in how healthcare providers are paid.

Bellin-ThedaCare Healthcare Partners, a collaborative organization comprised of Bellin Health in Green Bay, Appleton-based ThedaCare and a network of 700 physicians, was ranked No. 1 nationally by the Centers for Medicare & Medicaid Services (CMS) for quality measures in its pilot Pioneer Accountable Care Organization. At the same time, Bellin-ThedaCare also boasted the lowest average cost. Krueger, executive director and medical director for partnership, says the organization is responsible for managing the care of 20,000 patients on Medicare and Medicaid.

“Our organization has a long history of quality improvement and honestly the payment systems were holding us back from moving forward since we weren’t being rewarded for quality,” Krueger says.

In the current payment models, insurance companies and Medicare pay more money to healthcare providers as patients become sicker. But if healthcare organizations can provide better care – for example preventative care that catches health problems before they develop into serious (and costly) diseases – they are essentially losing out on potential revenue since patients are healthier. The goal, Krueger says, is moving towards a payment model that rewards health systems for keeping patients healthier.

“We were able to help patients become healthier, which kept them out of hospitals and that affected our bottom line,” he says.

Krueger says Bellin-ThedaCare is in talks with insurance companies to mimic the payment structure that the organization has in place with CMS. In the second year of the Pioneer ACO, the organization saved $3.2 million for CMS. Of that, $2.2 million will be shared with Bellin- ThedaCare, which will use to invest in other improvement efforts.

“It all comes down to having the payers – such as the insurance companies – paying for outcomes,” he says. “The changes we have made to improve quality and care weren’t just for the 20,000 CMS patients, but also went through all of the nooks and crannies of our organizations.” Bellin-ThedaCare was one of about 30 organizations nationwide selected to participate in the CMS pilot program in 2011 and is currently finishing up the third and final year of the pilot.

There is an option to renew for two more years, which Krueger says the organization is looking at.

While being No. 1 in the nation is nice, Krueger says it’s more important that patients that are receiving better care at a lower cost. When people ask how it’s been done, he says one example is a patient with a chronic disease, such as diabetes. If he sees his physician regularly at a clinic and is taught about the importance of monitoring his glucose levels, it’s less likely that more serious (and costly) complications develop.

“There’s still work to do. We can do a better job at coordinating care and identifying potential health issues in patients before they become a problem,” Krueger says. “The goal is to keep the population healthier. Doing that will help us lower healthcare costs overall.”

*Kicking it up a notch*

The University of Wisconsin-Oshkosh released an updated version of its campus sustainability program this past week and one of the “greenest” colleges in the state is setting even higher standards for itself.

For example, the college is looking to route 90 percent of its organic waste to one of its biodigesters and also develop a student-run greenhouse. There are academic goals too including creating leadership and green dot certificate programs in the college’s Sustainability Studies program.

“What makes the new plan different from our old one is that we are approaching this more like a ‘living document,’” says Jim Feldman, associate professor of Environmental Studies & History. “Rather than publishing a plan that we hope to guide us for the next five years, we are laying out our goals and vision with the intent to return to the plan every year or two to update it and to respond to new opportunities and conditions.”

Read more about UW-Oshkosh’s sustainability efforts: http://www.uwosh.edu/sustainability/csp-1/csp-1/csp-intro

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