This year, the business model for delivering $7 billion of medical care here in Minnesota is undergoing wholesale changes. The good news is that it is a model familiar to dentists: prevention-focused, patient-centered care. Health systems will quickly determine they need dentists to help their patients achieve improved health. This presents an opportunity for Minnesota dentists looking for new patients and new revenue sources.
Two separate but related announcements in mid-December lay out the opportunities: a large pool of patients that will be seeking care in a new business model. The Minneapolis St. Paul Business Journal released the list of the Top 25 Minnesota health care providers ranked by revenue. Allina Hospitals and Clinics, Fairview Health Services, and Park Nicollet Health
Services were ranked numbers 3, 4, and 6 on their list for fiscal year 2010, with a combined revenue of close to $7 billion. These three health systems also sought and were selected by the Centers for Medicare and Medicaid Services in December to participate in the Pioneer ACO Model.
What is an ACO? ACO stands for an accountable care organization. An accountable care organization is a health system that is designed to offer coordinated, patient-centered care that moves away from fee-for-service. An ACO converts its operations away from payment based solely on more and more procedures to one that focuses on achieving the goals of providing better care to patients, thus reducing the cost burden to employers and taxpayers. By transforming their operations, an ACO takes the financial risk and reward opportunities away from the health insurers and assumes them for their community. Health systems will have the freedom to decide how to deliver better care for individuals and keep their communities healthier in exchange for keeping the savings and avoiding insurance company interference.
As well, it is not only Medicare and Medicaid that are paying our Minnesota health systems in this new model. Most major insurers in Minnesota are changing how they pay medical providers. Shared savings models are offered to any health system wanting to make this move, because the financial trajectory of the old model is unsustainable to employers and taxpayers. Allina, Fairview, and Park Nicollet will move the quickest. As pioneering ACOs, they have pledged to move at least 50% of their revenue to this new financing mechanism by December 2013, less than two years from now.
What will it mean to Minnesota dentists when $7 billion goes into these three pioneering ACOs? With a commitment to better care of individuals and better health of their community in exchange for financial accountability, the traditional health system will be looking for new ways to keep people healthy. Dentists should be a major solution to this problem. Dentists have historically demonstrated the economics of prevention. We can be their early alert system for people with undiagnosed diabetes, hypertension, and heart disease. And we can bring our expertise to achieving complete health for individuals by reconnecting the mouth to the body as a part of their accountable care commitment.
The current business model for dentistry is working well. But health systems are on a certain path to take on financial responsibility for keeping Minnesotans healthy. With all the value dentists have to bring to ACOs, we will be in a strong position to design the financial partnership now. And we, in turn, will have our health professional colleagues as a larger distribution channel. Let’s make this shift in the business model of health care good for all involved.
*Dr. Riggs is Interim Associate Dean for Academic Affairs, University of Minnesota School of Dentistry, Minneapolis, MN 55455. E-mail is firstname.lastname@example.org.