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Health & Science

Health Organizations Come Together to Provide Better Care for Less

Health Care Reform

The U.S. is inching closer to the Affordable Care Act. On October 1, people can begin signing up for health insurance plans on the new federal exchange. One goal of the law is to help make health care more affordable. Another strategy being used-- ACO’s or Accountable Care Organizations. Four more local hospital systems recently signed onto one. It will begin in January.

ACOs are networks of health care providers. They include doctors and hospitals that sometimes have been long-time competitors. What they do when they come together is share information about patients.Timothy Hill is a doctor with United Healthcare.

“You don’t want to repeat tests that are unnecessary, you don’t want to prescribe something that could cause side effects because you’re not aware of the other care,” Hill says.

Hill says if providers prevent mistakes and avoid duplication, costs should go down for them and insurers, while patient care improves. United Healthcare is the latest insurer to sign onto an ACO in the area. Its providers include Froedtert, the Medical College of Wisconsin, Columbia St. Mary’s and Agnesian in Fond du Lac. The ACO managing the network is called Quality Health Solutions. Peter Pruessing heads it.

“We’re talking about 53,000 specific patients who’ve been identified, but United Healthcare estimates that there’s the potential for 100, 000,” Pruessing says.

Pruessing says the health systems will connect on 19 metrics for patient care and place a lot of attention on preventative steps. For example…

“Breast cancer screening, cervical cancer screening, cholesterol management, about five different measures of diabetic care,” Pruessing.

Pruessing says the ACO will pay physicians and hospital systems based on the quality of care they provide. He says that means considering such factors as readmission rates, length of hospital stays and patient satisfaction.

While there’s evidence the strategy could lead to cost savings and improved care, it’s too early to know just how successful the new ACOs will be, according to Donna Friedsam. She works for the UW-Madison Health Population Institute.  And Friedsam says there are fears about folding together competitors.

“People do get concerned that (this) could result in anti-competitive forces in the market such that providers are buying up one another and then they’re reducing the competition among providers,” Friedsam says.

Less competition could lead to higher charges. While the newest ACO will indeed bring together rivals, they still face outside competition. Months ago, Aurora Health Care rolled out its own Accountable Care Organization.