BizInsights This content is part of BizConnect and is made possible by our sponsors. Click here to learn more.

An ACO can keep employees healthier and lower costs for employers

Find out how an ACO could work for your company

John Foley - President, Wisconsin Collaborative Insurance Company
John Foley is president of Wisconsin Collaborative Insurance Company and also serves as the SVP of business development at Aurora Health Care. Foley has more than 30 years of industry payor experience, previously serving at Anthem Blue Cross and Blue Shield as vice president of provider solutions. Wisconsin Collaborative Insurance Company (WCIC) is a joint venture of Anthem Blue Cross and Blue Shield and Aurora Health Care.

Employers have a vested interest in improving the overall health of their employees. Partnering with a high-performing Accountable Care Organization (ACO) can help employers improve health care quality and reduce the costs of health coverage for their employees.

How does an ACO work?

ACOs are groups of doctors, hospitals and other providers who band together to provide integrated, evidence-based care in a cost-effective manner. When an ACO succeeds in delivering both high-quality care and using resources more wisely, it shares in the savings.

By keeping patients healthier and out of the hospital, ACO providers can earn additional reimbursement. This contrasts with traditional fee-for-service care where doctors and hospitals are paid for each test and procedure – with payments based primarily on quantity of care, rather than quality of care.

How can an ACO benefit employees?

ACOs must meet specific quality measures, focusing on prevention and management, especially for people at high risk or with chronic diseases. Many factors affect health care outcomes, including the patient’s own health habits and behaviors. This is especially true for patients facing chronic diseases such as heart failure, diabetes or COPD.

A high-functioning ACO employs evidence-based care and new technologies to help educate and engage patients so they can better manage their own health. They are more likely to comply with their care plan when actively partnering with their health care team. With an ACO, patients receive a higher level of coordinated care, leading to greater satisfaction.

How can an ACO benefit employers?

Employers who focus on keeping their employees well and managing their health conditions more effectively may see health care costs decrease over time. An ACO solution can mean:

  • Lower absenteeism;
  • Improved employee engagement and retention; and
  • Decreased overall health risks, treatment costs and unnecessary hospitalizations.

How does an ACO achieve these goals?

One way is seen in Advocate Aurora Health’s ACO product, referred to as High Performing Networks, which uses an integrated, coordinated multidisciplinary team approach. For example, some employers have an on-site Advocate Aurora nurse to help employees:

  • Learn more about their individual health risks and conditions;
  • Monitor chronic conditions such as diabetes or high blood pressure;
  • Get connected to a primary care provider for ongoing care; and
  • Navigate the health care system.

Focusing on cost drivers

Individual health counseling for high-risk individuals can greatly reduce health costs and manage the course of a disease or future hospitalization. Additionally, an ACO offers better management for those with a chronic condition. For example, Advocate Aurora nurse navigators and care coordinators provide personalized, integrated care for these patients who can drive a high percentage of health care costs.

ACOs help improve access to primary and low-acuity care sites like urgent care clinics, ensuring patients get the right care at the right time at the right cost. This reduces costly emergency department visits.

Electronic health record: The ACO connection

The electronic health record (EHR) is key to an ACO’s success. When providers have fingertip access to complete and accurate information, patients receive higher quality care. As an example, Advocate Aurora’s EHR allows all its health care providers, clinics and hospitals to securely share vital patient information, as well as track progress over time.

EHRs can enhance patient outcomes by:

Want to explore more about how an ACO may be right for your company? Visit Advocate Aurora’s Employer Solutions and click on High Performing Networks. Other solutions customized to your company’s culture could include employer clinics, wellness, occupational health, employee assistance programs (EAP), executive health programs and more.

Advocate Aurora Health is one of the 10 largest not-for-profit, integrated health systems in the United States and a leading Midwest employer, with more than 70,000 employees and the region’s largest employed medical staff and home health organization. The system serves nearly 3 million patients annually in Illinois and Wisconsin.

Get our email updates