292019Mar

ACO Re-Enters Medicare Shared Savings Program in July

After a short hiatus in 2018, CHI Saint Joseph Health Partners (Health Partners) anticipates a July restart in the Medicare Shared Savings Program (MSSP), which will allow the organization to continue its work to accelerate better health, better care, better experience, and lower costs for Medicare beneficiaries.

Accountable Care Organizations (ACOs) like Health Partners coordinate the care of Medicare beneficiaries with an annual spending target, or benchmark, and a series of quality thresholds. When providers in the ACO better coordinate care and spend less than the benchmark, they share in the savings. If the spend is higher than the benchmark, the ACO must return the overspend to CMS.

In addition to the shared savings, because Health Partners is an “Advance ACO,” its physician participants will receive the maximum bonus for their Medicare quality scores in the MIPS/MACRA program.

“Given Health Partners’ previous positive record with MSSP, we are confident we will be approved for the July start date,” said Health Partners President and CEO Don Lovasz. “And like before, this program accepts assigned Medicare patients from across the state. So in addition to our focus in Lexington and London, we will continue working with our participants in Louisville and Bardstown. Most of the medical groups, hospitals, home health agencies, and skilled nursing homes that previously participated have asked to be included in this new engagement.”

Of the nearly 500 ACOs across the country, Health Partners was one of the leading ACOs in the program from 2013 to 2017, spending less than benchmark all five years and saving the Medicare program more than $32 million. CHI Saint Joseph Health Partners is one of the few ACOs that consistently had year-over-year outcomes better than budget, while still meeting the quality thresholds of the program.

“Our multi-disciplined teams not only work with beneficiaries’ families and doctors on medical conditions, we also address the social determinants of health on high-risk patients,” said Dorothy Lockhart, Regional Director, Lexington Market. “This added dimension has helped set us apart.”

If accepted by CMS, Health Partners will gain the necessary organizational approvals to engage in the MSSP effective July 1, 2019. This version of the MSSP is a longer five-and-a-half-year contract, although there are options to exit the program if something unanticipated happens.

“The program is a natural fit for Health Partners because it aligns with our four pillar goals of better health, better care, better experience, and lower costs,” Lockhart said. “It aligns the cost saving incentives with improving the key quality metrics, which is pivotal to accelerating better outcomes.”

For more information on the CMS Medicare Shared Savings Program, visit the CMS website here.