The U.S. Centers for Medicare and Medicaid (CMS) recently announced the 2019 results for Accountable Care Organizations (ACOs) participating in the Medicare Shared Savings Program. In just its second year in the program, Castell Accountable Care (previously Intermountain Accountable Care) received a quality score of 98.88 percent, placing it among the top 5 percent of ACOs nationally for quality. Simultaneously, the Castell ACO generated $10 million in savings for Medicare.
The savings amount is four times the amount Castell saved Medicare in 2018. Nationally, only 20 percent of ACOs that started in 2018 earned savings in both 2018 and 2019. Intermountain Medical Group was the sole participant in the Castell ACO during these years.
ACOs are groups of healthcare providers that voluntarily agree to be held accountable for the quality, cost, and experience of care for a population of fee-for-service Medicare beneficiaries. Reducing Medicare spending saves the government and taxpayers money. The Medicare Shared Savings Program provides incentives for healthcare providers to keep patients healthy, improve health quality and patient outcomes, and lower costs. CMS evaluates how well each ACO meets these goals every year.
The Castell ACO generated savings for Medicare by keeping cost growth slower than the national average. This comes primarily through helping patients stay healthy to eliminate avoidable hospitalizations and smoothly transition home following a hospitalization. Performance on quality measures is a reflection of Intermountain’s low readmission rate, strong management of chronic conditions, and high patient experience ratings. Intermountain continued to improve on these measures in 2019, particularly in diabetes management and completion of falls risk assessments.
High performing ACOs receive a portion of any savings that result from reducing costs and meeting quality requirements, which helps support improvements in patient care. Per program guidelines, the ACO will receive $4.95 million of the savings, which will be used to reinvest in resources aligned with the ACO’s mission, such as creating additional data tools to improve quality and outcomes, providing primary care in the home, and forming better partnerships with specialists to ensure high-value specialty care.
More information is available here.