The Centers for Medicare & Medicaid Services (CMS) has announced the 2015 performance year results for its Medicare Shared Savings Program (MSSP) and the Pioneer Accountable Care Organization Model. Results show physicians, hospitals and health care providers participating in Accountable Care Organizations (ACO) continue to make significant improvements in the quality of care for Medicare beneficiaries, while achieving cost savings.
In 2015, Medicare Accountable Care Organizations had combined total program savings of $466 million. This includes all Accountable Care Organization experiences for 392 Medicare Shared Savings Program participants, and 12 Pioneer Accountable Care Organization Model participants. The results show more Accountable Care Organizations shared savings in 2015 compared to 2014, and those with more experience tend to perform better over time.
Medicare ACOs are groups of doctors, hospitals, and other health care providers, who come together voluntarily to provide coordinated high quality care to their Medicare patients. The goal of coordinated care is to ensure patients, especially the chronically ill, get the right care at the right time, while avoiding unnecessary duplication of services and preventing medical errors. When an ACO exceeds quality and financial thresholds – demonstrating achievement of high-quality care and wiser spending of health care dollars – it is able to share in the savings generated for Medicare.
Adena Healthcare Collaborative LLC, an entity within Adena Health System, was one of only three ACOs in the state of Ohio to begin it program Jan. 1, 2015. Adena, in its first year, surpassed all 33 of the program’s quality metrics and achieved a program savings of more than $5.2 million. Once shared with CMS, Adena will see a net reimbursement of more than $2.5 million, representing its half of the cost savings achieved.
“Adena’s providers and caregivers work diligently to give all patients the right care, in the right setting, at the right time,” said Dr. H. Takaji Kittaka, Jr., Adena Health System’s Chief
Medical Officer for Primary Care/Medical Director for Adena Healthcare Collaborative. “We are extremely pleased with our ACO’s successful inaugural year, and the resulting cost savings."
The focus of Adena’s ACO was on a population of 8,583 patients covered by Medicare. Dr. Kittaka added, “Care beyond the clinic is extremely important for the success of not only the ACO, but the overall success of the patient.” As part of its Population Health efforts, Adena’s nurse navigators, care coordinators, case managers, and more reach out to patients to follow-up with them after discharge or medical appointments. These caregivers make sure the patient understands their provider’s instructions, have the medication they need, and they also work to eliminate any barriers that can compromise a patient’s overall health outcome.
Reimbursed Medicare funds will be used to cover the ACO’s operating expenses, as well as those of the Adena Medical Group and Adena Health System.