1. Tracking patients with chronic health problems. Insurers will be paying hospital-and-clinic systems based on how well patients fare. People with multiple health problems, such as high blood pressure and diabetes, face much higher risks of expensive crises. That means there is much more opportunity to prevent excess care and spending on them than there is on healthy people. Dr. David Swieskowski, a vice president of Des Moines' Mercy Medical Center, shared financial numbers that illustrate why chronically ill people are the prime target for quality-improvement efforts. Wellmark Blue Cross and Blue Shield pays Mercy's ACO about $960 per month to care for patients with two or more chronic conditions, he said.