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Vision for future of local health care unveiled to Willmar, Minn., area providers

WILLMAR -- Local health organizations were handed an opportunity this week to redesign how they care for patients.

What's envisioned is a complete realignment of how doctors and hospitals are paid, with rewards for making patients better and information technology to guide decision-making and ensure fewer patients fall through the cracks.

It would be hard work but it's possible, Garrett Black of Blue Cross and Blue Shield of Minnesota told a roomful of local hospital and clinic leaders Thursday night.

"I think there's a way to get there but we need to hear from you," said Black, vice president of network management with Blue Cross.

Black and Dr. Gregory Gilmet, vice president and chief medical officer for health management with Minnesota Blue Cross, outlined a vision of the future Thursday for doctors, administrators and board members with Affiliated Community Medical Centers, Family Practice Medical Center and Rice Memorial Hospital.

The meeting was organized and hosted by the city-owned hospital. Mike Schramm, chief executive, said there has been discussion for some time about expanding the board's knowledge about the Patient Protection and Affordable Care Act of 2010 and its likely local impact.

"I felt it was important that we have some education for the group," he said.

Nearly two years after the passage of the health care reform law, many questions remain about its implementation, especially in rural health care markets that aren't large enough to sustain the accountable care organizations -- essentially large, integrated health care delivery systems providing care for a defined population -- that are among the centerpieces of the law.

There's no model for how such a concept might work in Willmar, the Blue Cross officials acknowledged Thursday night.

"We haven't done this before. ... It's a new house design for us," Gilmet said.

But preliminary results from a Blue Cross initiative to create what's called "aligned incentive contracting" suggest the accountable care model indeed is reducing costs and improving quality and outcomes among the large delivery systems that have adopted it, Gilmet and Black said.

Under the old way, doctors and hospitals were paid according to how many procedures and office visits or hospital admissions they had, with bonuses tacked on for meeting performance goals.

The new Blue Cross contract structure, which is in place at Allina, Sanford Health, CentraCare and others of Minnesota's largest health systems, still pays on the basis of volume but this portion of the formula is being reduced over time and replaced by payments that support quality care and better outcomes for patients.

It allows providers to rely less on volume and concentrate more on quality, Gilmet said. "There's an upside for providers. They get rewarded for solid outcomes."

The initiative also uses the patient-centered medical home model, which places patients with a team of clinicians coordinating their overall care.

What it means for patients is less fragmentation, more consistency and an opportunity for better outcomes, Gilmet said. "It's that team-based approach that appears to be making the most difference."

The experience also should be better for patients, he said. "If their experience has been suboptimal, then we have failed in our design."

It's far too soon to know whether local providers will decide to develop a similar model, or "accountable care community." Major questions must first be answered -- among them, whether the clinics and hospitals want to tackle this as a group or whether each will pursue it independently, and how willing they are to plow untested ground. There's also potential for other partners to be brought in, such as local pharmacies or social services.

"It would be a little more complicated than we've done to date but there is a way to do it," Black said.

"We'd like to know: Where do you want to go from here?" he said.

With health care costs continuing to rise faster than all other types of spending, the status quo has become unsustainable, Black said. Redesigning how systems take care of patients and how they get paid could be "our last chance" to rein in runaway costs before the government steps in with mandates, he said.

Anne Polta

Anne Polta covers health care, business/economic development and general assignment. Her HealthBeat blog can be found at Follow her on Twitter at @AnnePolta.

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