Tennessee Health System Charts Its Own Course

Mountain States is also evaluating its opportunities in the Medicare Shared Savings Program and plans at the minimum to file a letter of intent. If selected for the program, those beneficiaries would be housed in a separate Medicare component of the ACO.

Early last year, the 15,000 lives associated with the employee group were transitioned into CrestPoint Health to begin the process of managing employee health and wellness in a coordinated manner. Care models developed around congestive heart failure, pediatric asthma, and diabetes will be part of the ACO.

Among the first steps was to put in place front-end incentives of $750 (individual) and $1,500 (family) as seed money for each health savings account. That effort increased participation to 48% from 18%.

Additional incentives will be introduced around the theme of "get healthy, be healthy, stay healthy," including:

• Monetary rewards for using company wellness and fitness centers.
• A freeze on annual insurance premium increases for completing a health risk assessment.
• A copayment waiver for using MSHA's urgent care centers instead of the hospital emergency room.

There are no shared savings built into the first year of the commercial component of the ACO, but that may come later. It has negotiated increased payments, per member per month, to the primary care physicians to try to keep the population healthy and better manage patient health to avoid preventable hospitalizations or the use of other expensive healthcare services.

This article appears in the May 2012 issue of HealthLeaders magazine.