MaryBeth Matzek: Bellin-ThedaCare tops in national Medicare program

This is an excerpt from a column posted at BizOpinion.

Dave Krueger sees Bellin-ThedaCare Healthcare Partners’ success at providing high quality care while keeping costs in line as a potential game changer in how healthcare providers are paid.

Bellin-ThedaCare Healthcare Partners, a collaborative organization comprised of Bellin Health in Green Bay, Appleton-based ThedaCare and a network of 700 physicians, was ranked No. 1 nationally by the Centers for Medicare & Medicaid Services (CMS) for quality measures in its pilot Pioneer Accountable Care Organization. At the same time, Bellin-ThedaCare also boasted the lowest average cost. Krueger, executive director and medical director for partnership, says the organization is responsible for managing the care of 20,000 patients on Medicare and Medicaid.

“Our organization has a long history of quality improvement and honestly the payment systems were holding us back from moving forward since we weren’t being rewarded for quality,” Krueger says.

In the current payment models, insurance companies and Medicare pay more money to healthcare providers as patients become sicker. But if healthcare organizations can provide better care – for example preventative care that catches health problems before they develop into serious (and costly) diseases – they are essentially losing out on potential revenue since patients are healthier. The goal, Krueger says, is moving towards a payment model that rewards health systems for keeping patients healthier.

“We were able to help patients become healthier, which kept them out of hospitals and that affected our bottom line,” he says.

Read the full column for more