Seven Sponsored Medicare Shared Savings Programs Deliver High Quality and Demonstrate Significant Savings
Prominence Health Plan, a subsidiary of Universal Health Services (UHS), announced the 2019 results of its seven UHS Accountable Care Organizations (ACOs) showing a continued trend of increased cost savings and improved quality. In 2019, the ACOs saved Medicare $90 million, earning $40 million for its 3,000 participating physicians. The savings increased by nearly 40 percent compared to 2018 due to continued improvement in value-based care delivery by participating ACO providers, as well as through expansion of the ACO programs to new markets. Since the establishment of the first UHS ACO in 2014, the entities have saved more than $207 million and averaged a 97 percent quality score.
The California Clinical Partners ACO ranked first in the California 2019A cohort for total Medicare savings of $5.1 million in its first partial year of participation in the Medicare Shared Savings Program (MSSP).
Within the shared savings program, providers can earn back part of the savings they generate for Medicare by achieving predetermined quality-of-care goals. This model rewards both the patient and physician as the patient receives better healthcare and the physician is incentivized for keeping them as healthy as possible and providing high quality care. "This continued success is due to intentional partnerships within UHS communities, empowering local primary care clinicians with the necessary data and resources to provide high quality, high value care," said Kamal Jemmoua, CEO, Prominence Health Plan.
ACOs are groups of physicians who agree to reduce costs and increase quality within a value-based contract, which results in a shared savings agreement. Physicians are incentivized to bend the healthcare cost curve, manage utilization and maintain high quality care by shifting from volume-based payments to value-based payments. Within the shared savings program, providers can earn back part of the savings they generate for Medicare by hitting pre-determined spending goals.
UHS ACOs are physician-led and sponsored either wholly by UHS or in a joint-venture partnership with ACO participants depending on the structure of the ACO. The ACOs are focused on primary care with community partnership in post-acute and specialty care.
"The California Clinical Partners ACO makes a direct impact on the health of our community," said Richard Allen, CEO of Palmdale Regional Medical Center. "This program encourages providers to spend extra time with patients ensuring that their needs are being met. It’s about building relationships with our patients and all the providers along the continuum of care to ensure every patient receives the right care at the right time in the right setting."
Hospital sponsorship is a differentiator in UHS ACOs as the hospitals partner with participants to provide capital funding, partnership in downside risk, and integrated ACO-friendly hospital initiatives focused on avoiding unnecessary utilization and increasing communication with ACO providers. The support from UHS facilities enables ACO leadership and governance to be driven by participating providers in the community – a vital component to success in value-based care.
UHS also provides administrative oversight and data analytics for ACO operations in addition to ACO-friendly hospital initiatives within each UHS facility. These initiatives include PCP notification of ACO beneficiary admit/discharge, ACO patient flags within the hospital EMR, partnerships with hospitalists and ED providers to ensure appropriate utilization, and integrated case management navigating PCP communication and post-acute care.
The Centers for Medicare and Medicaid Services (CMS) established the ACO program to improve the quality of care for Medicare beneficiaries and lower Medicare costs. If an ACO achieves high quality and saves money for Medicare, then the ACO shares in those savings. Since the beginning of the ACO program in 2013, ACOs have saved Medicare $5.2 billion.