Essentia Health Duluth introduces a new health care model

Health care has always been a hot topic of debate in our country. If President Barack Obama’s Patient Protection and Affordable Care Act (PPACA) continues, the included mandates will require everyone to have health insurance, leaving certain people, including students, concerned about how to afford it. However, Essentia Health of Duluth may have the solution.

Essentia Health of Duluth plans to introduce a new health care model called an Accountable Care Organization, or ACO, which promotes affordable and quality healthcare.

Dr. Michael Van Scoy, M.D., of Essentia Health Duluth, and vice president of Payor Contracting and Strategy Catherine VonRueden, collaborated their knowledge and efforts to make Essentia Health of Duluth an ACO, one of the first Medicare ACOs in the country, and are working to create more.

“This will create more access to affordable health care for students that will be uninsured,” said Van Scoy. “Young people are really struggling with getting affordable health care and ACOs will make that a lot easier.”

According to Brian Rank, Medical Director of HealthPartners Medical Group, ACOs promote quality care while keeping costs low. They are based around what is called the “Triple Aim”: improving health, improving patient experience and reducing costs.

“When people have health insurance with the help of the government, they will be more likely to seek preventative care,” says VonRueden. “This preventative care will make sure people are healthy, reducing emergency room visits or serious future illnesses.”

Serious illnesses call for more intensive treatments, testing, and readmission to doctors, which raise costs. ER visits are extremely expensive too. 

Under ACOs, doctors will also be required to be sure that their patients are going to follow up appointments, keeping up with their prescriptions, and seeing the doctors to which they are referred. Being sure of this will also reduce the instances listed above.

“This is the end of a fee for service system and the beginning of a value based system where patients get the quality of care that they are paying for,” said Van Scoy. “We need to be able to prove to patients that they can trust us to give them good quality care for the money they pay.”

This may seem like it only benefits the patients and puts more work on the doctor’s being that they take more responsibility for care. But the doctor’s have incentive as well.

Together, the insurance companies and the health system design a contract including certain quality measurements that need to be met along with an annual cost target. At the end of the year, they review how the provider’s measurements compare to those on the contract. The insurance company reimburses the health system with the saved money.

“We need to realize what sort of world we are going into,” said Van Scoy. “The rising cost of health care finance is going to place a burden onto our future generations. We need to make a change.”


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