GRMC Partners with Mercy for CMS Innovation Award

Grinnell Regional Medical Center announced it is participating in the $10.1 million Health Care Innovations Award from the Centers for Medicare and Medicaid Services (CMS) with the Mercy Accountable Care Organization/Mercy Health Network. As a participation site for the Mercy ACO, GRMC will receive funding as it transitions to value-based care and helps create delivery models for the future of healthcare.

“Value-based care will shift the payment of healthcare services toward keeping our community healthy rather than generating payment from an illness or injury,” says Todd C. Linden, GRMC president and CEO. “The goal of this award is to create new models of care and payment for Medicare and Medicaid that can be used by hospitals across the nation. We are pleased to be part of the innovation award and at the front of this movement in healthcare.”

Currently, Medicare pays doctors and hospitals a set amount for each service provided. As a service is provided, a fee is generated for every test, procedure, exam, or treatment.

This new value-based approach focuses on working to keep people well in the first place. Medicare identifies a group of patients attributed to a physician and then estimates the costs associated with providing care to that group of patients in the coming year. The providers are paid in the same fee-for-service approach, however if at the end of the year the actual amount spent is less than the estimates, those savings are shared with the providers. In this way, an incentive is created to keep people healthy and to make sure care is provided in the most effective and efficient way possible. It creates an incentive to keep quality high and costs low.

“This innovation award through the Mercy Health Network allows us to create models that work in a rural setting for improving community health, creating better patient experiences, and reducing costs,” Linden says. “It lines up with the mission we’ve had as a healthcare organization all along.”

GRMC officially became a member of Mercy ACO/Mercy Health Network on January 1, 2015. The award is part of the CMS Health Care Innovation Awards through the U.S. Department of Health and Human Services. The Mercy ACO was established in July 2012 under the Medicare Shared Savings Program.

 “Our board of directors and the medical center’s administration agreed to participate in this ACO because it has great opportunity for GRMC to serve as a leader in creating a successful model of value based care.” Linden says. “Mercy’s program was the only accountable care organization in Iowa this past year that achieved shared savings through the Medicare Shared Savings Program. Mercy is a very high performing ACO and GRMC will benefit from what they have already learned.”

Mercy ACO is made up of a team of healthcare providers working together to coordinate patient care. The ACO combines the entire range of patient care – primary care provider, specialists, hospitals, home health services, etc. – that shares financial and medical responsibility for providing coordinated care to patients in hopes of limiting unnecessary spending and keeping costs low while providing excellent healthcare.

It also recognizes that individuals themselves need to be engaged and provided ongoing education and support to make healthy lifestyle changes. To achieve this, the health coach is an important part of the ACO.

“We’ve had a health coach associated with the GRMC affiliated primary care clinics over the past few years. The award will provide additional resources for our efforts,” Linden says.

Another key component of the award will be resources to track and monitor community health. The agreement allows sharing of information to improve or maintain the health of residents. The award will help fund information systems and software to track health factors and create a disease registry. So ACOs can identify people with health risks and work with them to reduce those risks for greater health and wellness.

The local clinics participating in the CMS innovation award and the Mercy ACO include Family Medicine, Grinnell Regional Family Practice, McCaw Family Medicine, and Grinnell Regional Internal Medicine.

Through the 100 member organizations in the Mercy ACO, more than 160,000 people could see benefits through better management of chronic conditions such as heart disease, high blood pressure, and diabetes. This project will use the successful health coach model developed by Mercy Clinics in Des Moines. Health coaches are achieving good results through education, prevention activities, and providing ongoing patient support for living well. GRMC is excited to be part of this innovative model and groundbreaking work for rural Iowa healthcare.

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“The project described was supported by Award Number 1C1CMS331327 from the

Department of Health and Human Services, Centers for Medicare & Medicaid Services.”

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The contents of this publication are solely the responsibility of the authors and do not necessarily represent the official views of the U.S. Department of Health and Human Services or any of its agencies.

About Mercy ACO

Established in 2012, Mercy Accountable Care Organization (ACO) focuses on building a new health care model, concentrated on providing enhanced medical services while improving outcomes and lowering costs for all patients. Today, Mercy ACO includes 100 member organizations and covers the lives of approximately 117,000 patients in a variety of shared savings programs and value based contracts.