Allina Health has delivered its best-ever results in four years of participating in the Pioneer Accountable Care Organization Program. The Center for Medicare and Medicaid Innovation reports that in Performance Year 4 (2015) Allina Health saved Medicare more than $3.5 million over the projected spend for Medicare beneficiaries, while at the same time improving its quality score by greater than six percent over the previous year.
The payment to Allina Health represents 2.5 percent savings in the overall cost of care for the 15,000 traditional Medicare beneficiaries attributed to Allina Health in 2015. A portion of these savings will be made available to Allina Health to provide for ongoing infrastructure improvements and related administrative costs
“Allina Health has participated in Medicare’s Pioneer ACO Model since 2012, because we support CMS’s desire to move from fee-for-service payments to value-based payments. We have saved CMS about $7.5 million over the last three years by focusing on high-value care, preventing complications and readmissions, improving access for primary care, adding new care management programs, and helping patients understand their conditions and options,” said Penny Wheeler, MD, Allina Health President and CEO.
Rodney Christensen, MD, Allina Health Vice President of Medical Operations, Network Division, attributes Allina Health’s success to increasing experience and expertise as an accountable care organization.
“We have taken on a greater level of risk and accountability as we have learned. Our shared savings payment includes an assessment of the quality of our work, and we are proud we achieved 95 percent of the maximum quality score,” Christensen said.
The 33 ACO measures that make-up the quality score are divided into four categories: Patient/Caregiver Experience, Care Coordination/Patient Safety, Preventive Health and At-Risk Population. Allina Health scored well across these categories and significant gains were made in screening and treatment in areas like hypertension, coronary artery disease, falls, and immunizations.
The central premise of the Medicare Pioneer ACO Model is to create value through a highly coordinated, collaborative network of providers who are focused on achieving the highest level of wellness and prevention possible for patients. Triggers alert the Allina Health team to beneficiaries who have chronic and acute illness or hospitalizations, so that patients can receive the highest level of support.
Medicare Pioneer ACO provider networks benefit financially when they return savings to Medicare in a value-based model, not through an increased volume of services that are reimbursed in a traditional fee-for-service model. Revenues are generated through a percentage of Medicare savings. Savings are realized through coordination of care and adherence to evidence-based care. If expenses are greater than the expected benchmark, that Medicare Pioneer ACO is at risk for a percentage of losses.