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UnityPoint Health’s participation in the initial rollout of CMS’ Next Generation ACO Model helped them succeed beyond their expectations in their transition to reimbursement risk.
In performance year 1 (2016), UnityPoint’s 85,000-member Iowa Health ACO earned more than $10.5 million in shared savings.
Like most health systems, UnityPoint still gets more revenue from fee-for-service than what Vice President and Chief Analytics Officer Betsy McVay calls fee-for-value, but she says the NextGen ACO model offered the health system an opportunity to transition to a value-based payment model.
“We know we need to be successful in risk models and, ultimately, full capitation, to provide the best quality care,” she says. “It’s absolutely necessary.”
Though most top leaders concede that not only is value-based care necessary, it’s also ethically better to make that transition, many executive leaders at hospitals and health systems struggle with how quickly and fully to embrace the commitment, given that the two reimbursement systems are diametrically opposed, and how thin healthcare margins can be.