Which health system was the first to introduce an accountable care organization (ACO) in Central Iowa? It depends on whom you ask.

Wellmark Blue Cross and Blue Shield officials say Iowa Health System was the first. However, Mercy Medical Center – Des Moines contends that it signed its contract with Wellmark the same day as Iowa Health.

Wellmark and Iowa Health issued a joint press release on April 26 announcing their intent to form an ACO. Mercy officials got wind of that and made their announcement the same day.

“I didn’t like the way it was announced; I didn’t think it was fair,” said Dr. David Swieskowski, Mercy’s chief accountable care officer. “We both signed contracts on the same day, and they announced Iowa Health System first. In fact, they wouldn’t even allow us to announce ours before that time.”

The insurer has worked with Iowa Health for the past two years on establishing its ACO, the longest it has worked with any health system, said Laura Jackson, Wellmark’s executive vice president of health-care strategy and policy. In May, the two organizations outlined Iowa Health’s ACO plans in a joint meeting arranged with the Business Record; Mercy outlined its plans to the Business Record without Wellmark’s participation.

“Mercy has been hard at work at this, there’s no doubt,” Jackson said. “We’ve certainly been at the table working with our colleagues at Iowa Health longer. Technically, (Iowa Health) was the first to sign the agreement.”

Bill Leaver, Iowa Health’s president and CEO, said the competition should center on which health system can best coordinate care to provide better value for patients.

“That’s where the competition ought to be, not who can do an MRI faster or get you in quicker,” he said. “But it has to be a combination of quality, patient experience and cost. That’s how we define value. Those three things have to be in the equation.”

Despite the choppy start with Wellmark, Mercy’s Swieskowski said he doesn’t feel the working relationship is otherwise skewed in Iowa Health’s favor.

“Wellmark tells us we have identical contracts; I believe that,” he said. “So we have identical incentives and identical potential rewards, and I’m very comfortable competing on that basis.”