Allegiance Health Group and ACO
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Medicare Shared Savings Program
Medicare Shared Savings Program Performance Year 2015 Results
The Medicare Shared Savings Program was established by the Affordable Care Act to facilitate coordination and cooperation among providers to improve the quality of care for Medicare Fee-For-Service (FFS) beneficiaries and reduce unnecessary costs. The program encourages providers of services and suppliers (e.g., physicians, hospitals, and others involved in patient care) to create a new type of health care entity, an ACO. ACOs agree to be held accountable for improving the quality of care for patients they serve while reducing health care spending. ACOs that improve quality and reduce spending receive a share of the savings achieved.
Shared Savings Program ACOs generated total program savings (inclusive of all savings and losses relative to financial benchmarks) of $429 million. Of participating ACOs, 119 Shared Savings Program ACOs earned shared savings by holding spending far enough below their financial benchmarks and meeting quality standards. No Track 2 ACOs owed CMS losses.
83 ACOs had health care costs lower than their benchmark, but did not qualify for shared savings, as they did not meet the minimum savings
An increasing proportion of ACOs have generated savings above their minimum savings rate each year. For PY15, 31 percent of ACOs (120 of 392) generated savings above their MSR compared to 28 percent (92 of 333) in PY14 and 26 percent (58 of 220) in PY13.
ACOs with more experience in the program were more likely to generate savings above their MSR. For performance year 2015, 42 percent of ACOs that started in 2012 generated savings above their MSR, compared to 37 percent of 2013 starters, 22 percent of 2014 starters and 21 percent of 2015 starters.
45 percent of ACOs participating in the Advance Payment model or ACO Investment Model tested by the Center for Medicare and Medicaid Innovation, which offer select Shared Savings Program ACOs pre-paid savings, generated savings above their MSR compared to 29 percent of all other ACOs.
Shared Savings Program ACOs that reported quality in both 2014 and 2015 improved on 84 percent of the quality measures that were reported in both years. The average quality performance improved by over 15 percent between 2014 and 2015 for four measures: screening for risk of future falls, depression screening and follow-up, blood pressure screening and follow-up, and providing pneumonia vaccinations. Over 91 percent of ACOs in a second or third performance year during 2015 increased their overall quality performance score through Quality Improvement Reward points in at least one of four quality measure domains.
Eligible professionals (EPs) who bill under the Taxpayer Identification Number of an ACO participant satisfied the Physician Quality Reporting System (PQRS) reporting requirements when their ACO satisfactorily reported quality measures on the EPs’ behalf for the 2015 reporting As a result, these EPs will avoid the 2017 PQRS payment adjustment and Value Modifier downward adjustment for failure to report. In addition, they may be eligible for upward payment adjustments based on their ACO’s quality performance under the 2017 Value Modifier.Type your paragraph here.
Year 1: 2014 - No Savings
Year 2: 2015 - Savings from Benchmark $ 2,087,468 Shared Savings $ 954,572
Year 3: 2016 - Savings from Benchmark $ 1,990,509 Shared Savings $ 0
Year 4: 2017 - TBD