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Premier Medicare ACOs Outperform Peers in Cost, Quality By 2:1

Medicare ACOs in Premier’s Population Health Management Collaborative were more likely to earn shared savings and higher quality scores in 2015, a report stated.

By Jacqueline Belliveau

- Medicare accountable care organizations (ACOs) that are part of Premier Inc.’s Population Health Management Collaborative (PHMC) outperformed other Medicare Shared Savings Program (MSSP) and Pioneer ACOs in earning shared savings and improving care quality by almost two to one, Premier recently announced.

Premier researchers found that Medicare could have saved nearly $1.36 billion in 2015, about three times more than the $466 million actually saved, if all other Medicare ACOs achieved similar cost and quality performance scores as Premier’s Medicare ACOs.

“PHMC members have demonstrated that smart planning, active physician leadership and professionally-managed implementation drives sustained quality and population health improvement,” stated Joe Damore, Vice President of Population Health at Premier.

“Even with benchmarks that are lower than the national average, these health system-sponsored ACOs are making an impact in a wide variety of communities across America and bending the healthcare cost curve,” added Damore.

PHMC Medicare ACOs fared better than their peers in regards to achieving shared savings payments in both the MSSP and Pioneer ACO model, the analysis showed. While about 30 percent of MSSP and Pioneer ACOs earned shared savings payments in 2015, half of the PHMC Medicare ACOs qualified for shared savings in the same year.

Researchers added that 2015 was the second year in a row that PHMC Medicare ACOs outperformed their peers in terms of qualifying for shared savings payments.

Experienced PHMC Medicare ACOs were also more likely to earn shared savings than their colleagues, Premier stated. About 80 percent of PHMC Medicare ACO members that joined the MSSP or Pioneer ACO model in 2012 qualified for shared savings in 2015 versus only 42 percent of ACOs that also started in 2012.

Stemming from their cost performance over the years, PHMC Medicare ACOs contributed to 22 percent of the total $1.29 billion in total Medicare savings since 2012, even though they only represent six percent of all participants in both programs.

Additionally, PHMC Medicare ACOs scored higher than average quality of care scores, the analysis stated. While the national quality performance scores were 91.5 percent, PHMC Medicare ACOs earned an average score of 93.8 percent.

In terms of specific quality measures, PHMC Medicare ACOs outperformed their peers on 19 out of 34 measures. For example, the ACOs scored higher than the national average by nine percent on percent of primary care physicians who successfully met Meaningful Use requirements and six percent on preventative care and screenings for influenza immunization.

PHMC Medicare ACO members attributed their cost and quality performance success on improving in the following five key areas:

• Care management improvement

• Post-acute care network optimization

• Robust population health IT utilization

• In-network utilization management

• Physician engagement

“Succeeding within these models is challenging, but these results show that a shared mission, effective collaborative execution model, peer-to-peer benchmarking and performance improvement along the way can help some make the transition faster, with higher-quality outcomes,” stated Melissa Gerdes, MD, Vice President and Chief Medical Officer of Outpatient Services and ACO Strategy at Methodist Health System, a PHMC Medicare ACO member.

In August, CMS announced that Medicare ACOs in both the MSSP and Pioneer ACO model saved over $466 million in 2015, with 125 ACOs qualifying for shared savings payments.

The federal agency noted that Medicare ACOs significantly improved quality performance in 2015. For example, 31 percent of MSSP ACOs produced healthcare savings beyond their minimum savings rate in 2015 compared to just 28 percent in 2014 and 26 percent in 2013.

Medicare ACOs, including 392 MSSP and 12 Pioneer organizations, also produced more shared savings compared to previous years, CMS reported.

“Accountable Care Organization initiatives in Medicare continue to grow and achieve positive results in providing better care and health outcomes while spending taxpayer dollars more wisely,” said Patrick Conway, MD, CMS Principal Deputy Administrator and Chief Medical Officer. “CMS continues to work and partner with providers across the country to improve the way health care is delivered in the United States.”

Dig Deeper:

Time, Commitment Required for ACO, Value-Based Care Success

What Are the Benefits of Accountable Care Organizations?

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