"We're establishing specific initiatives to address what the [anticipated] shortfall is," he adds. "We're also now focusing on entering into [commercial payer] contracts that will reward us for these types of activities."
In Iowa Health's ACO, patients are identified by providers for participation in the program and then are put into a system-wide, centralized case management program, which includes a home health organization. Last week, Iowa Health System and Wellmark Blue Cross and Blue Shield of Iowa announced the first commercial ACO for that state, agreeing to create ACO organizations in four markets across the state. (Two Iowa Health affiliates already operate a Pioneer ACO, using the Centers for Medicare and Medicaid Services model.) The commercial ACOs are:
"In our system we can pilot things in eight different regions—to see what works and what doesn't work—and not put the entire system in financial jeopardy until such time as we're ready to deploy things across the system," Vermeer says.