In 2012, UnityPoint Health formed an accountable care organization, becoming an early adopter of the model. Since its participation in the Pioneer ACO Program, the health system, which operates in Iowa, Illinois and Wisconsin, established a large version of Medicare's new Next Generation ACO, with 83,000 beneficiaries. Sylvia Burwell, secretary of the Department of Health & Human Services, recently visited UnityPoint's Fort Dodge, Iowa, branch, which includes Trinity Regional Medical Center, to applaud the tremendous success the health system has achieved in moving toward a value-based model of care. 

What has been UnityPoint’s experience with ACOs?

We’ve had a really good experience. We made the decision to enter into value-based arrangements and form the ACO before we had the full infrastructure in place to move from volume- to value-based care. We wanted to create a seamless experience for our patients and manage the health of populations. The early commitment has helped us to become a learning organization and continually explore new approaches. It has allowed us to build capabilities that, if we had stayed in traditional models, we couldn’t have done. 

We had already started down that path with a broad physician alignment effort that provided a solid, substantial foundation, but I think the most significant adjustment has been the development of analytics capabilities. We needed an analytics platform to allow a more comprehensive view of the population, including the impact our care was having and the potential for additional interventions to improve health. These analytics have allowed us to begin identifying who is likely to be readmitted or has additional medical issues so we can intervene early. It also creates a tighter connection with our patients. 

In most of our contracts, we’re earning a small shared-savings payment and we’re seeing quality improvements and patient satisfaction improvements. Today, those savings may be a smaller share of our revenues but, in the future, they will be key drivers to our success as a system. Currently, it’s more that they’ve allowed us to learn and help push the organization from a transformation standpoint. The culture we’ve created and the capabilities we’ve built make us comfortable that we can thrive in a future where the cost curve must be bent and outcomes must be measured.

What do you think the future outlook is for the ACO model?

Whether it’s called the ACO model or not, the concept of providers and provider networks taking responsibility and financial accountability for managing the health of various segments of a population will continue. I think it needs to continue in order for us to really get a strong hold around the cost of health care for our country. As an organization, we will keep pushing aggressively to increase the number of lives that are in value-based arrangements. Right now, we’re obviously in the federal government space with NextGen and in the commercial space with major payers in Iowa and Illinois. And we have close to 35,000 of our own members who are in our self-insured health plan. I think we’ll see continued expansion into Medicaid and we’ll continue to look for additional opportunities in commercial payers as well. We also are aggressively moving toward taking downside risk and will continue to move in that direction.

How does the ACO model fit in with bundled payments and other evolving models?

I think, overall, they complement each other well. A bundled payment can work inside of an overall value-based arrangement. To me, what the ACO concept has done is to help organizations like ours create broader and higher-performing networks of providers, whether they’re owned or aligned with us. It helps to create that alignment. The formation of the network helps us to transition into other evolving reimbursement models, because we’ve already built the relationships and the data systems necessary to do well under a variety of different payment models, including bundled payments.