Integrated Health Network of Wisconsin (IHN) exceeded its clinical quality goals in the first year of a three-year accountable care relationship with UnitedHealthcare, due to enhanced care coordination for patients and better sharing of clinical and financial data.
The results are based on the experiences of 60,000 employer-sponsored health plan participants who sought care from IHN physicians in 2014. During the first year of the program, more patients received the preventive care they needed, took action to manage their chronic health conditions, avoided unnecessary trips to the emergency room and increased their use of lower-cost generic prescriptions.
IHN’s Accountable Care Journey
IHN is Wisconsin’s first multisystem, clinically integrated accountable care network. In 2013, IHN and UnitedHealthcare took the first step toward an enhanced relationship that rewards delivering value rather than volume and created an Accountable Care Organization (ACO). With a shared commitment to more affordable and effective care that results in better health, the value-based relationship produced notable improvements in 2014 as compared to the practice’s clinical data from 2012:
– Breast cancer screenings increased by nearly 7 percent
– Colorectal cancer screenings increased by more than 5 percent
– Diabetic screenings increased by more than 4 percent
– Unnecessary emergency room use decreased by 4 percent
– The use of generic prescription drugs increased by more than 2 percent (compared to clinical data from 2013)
UnitedHealthcare complemented IHN’s own care management and data systems by supporting them in the transition to managing overall population health. This included technology and information that help the network’s thousands of physicians and care providers take specific actions that improve quality and lower costs, actionable data that help identify specific gaps in care that require action, and real-time information about emergency room and inpatient admissions to better manage a patient’s ongoing care. IHN’s patient care navigators reach out to patients discharged from the hospital and develop transition plans, schedule follow-up appointments, connect patients with community resources and close gaps in care.
“Our initial results with IHN clearly illustrate that aligning integrated data leads to better health and a better care experience,” said Dustin Hinton, president and CEO, UnitedHealthcare of Wisconsin. “We look forward to further enhancing our value-based relationship with IHN and helping its physicians transition to effective population health management.”
Today, more than 114,000 UnitedHealthcare employer-sponsored health plan participants have access to care with IHN through the ACO.
Accountable care programs like those with IHN move away from a fee-for-service compensation model to a value-based approach in which care providers are eligible to receive payment incentives based on patient satisfaction, achieving certain evidence-based measures – such as lower hospital readmission rates, effectively managing chronic conditions, and prevention – as well as total cost savings.
IHN continues to invest funds into technology enhancements to improve the quality of care, increase patient satisfaction and reduce health care costs. IHN’s network currently includes Agnesian HealthCare, Columbia St. Mary’s, Froedtert Health, Hospital Sisters Health System, the Medical College of Wisconsin, Ministry Health Care, Prevea Health, SSM Health and Wheaton Franciscan Healthcare. It also offers access to nearly 100 associated specialty care providers including Children’s Hospital of Wisconsin, Rogers Memorial Hospital, United Hospital System, chiropractors, skilled nursing facilities and more. In all, IHN represents more than 6,300 physicians and providers, 1,027 clinics and 49 hospitals across Wisconsin.
Care providers nationwide are showing strong interest in a shift to value-based care. UnitedHealthcare’s total payments to physicians and hospitals tied to value-based arrangements have nearly tripled in the last three years to $43 billion. By the end of 2018, UnitedHealthcare expects that figure to reach $65 billion. Today these programs touch as many as 13 million consumers served by UnitedHealthcare, delivered in part through more than 750 accountable care arrangements. This includes growth of more than 160 new accountable care arrangements so far in 2015.
UnitedHealthcare serves more than 1.5 million Wisconsin residents with a care provider network of 145 hospitals and almost 29,000 care providers statewide.
