CAMC Health Network, LLC, improved care for over 12,800 Medicare beneficiaries in central and southern West Virginia and saved Medicare $8,067,080 by meeting quality and cost goals in 2020, according to recently released performance data from the federal agency that administers Medicare.
The CAMC Health Network earned a quality score of 96.87% on performance measures ranging from preventive health checks to use of computerized health records to preventing avoidable hospitalizations, Medicare data show. The $8,067,080 of gross savings to Medicare resulted in a shared savings payment of $3,125,747 to CAMC Health Network, which will be shared between providers within the network.
“When providers work together through an ACO (accountable care organization) to focus on patients and invest in care coordination, information technology and other care improvements, they can both increase quality and reduce costs,” said Michelle Coon, president, CAMC Health Network. “ACOs like ours are measurably improving care and saving money while maintaining patient choice of Medicare providers.”
For example, CAMC Health Network providers work to increase the number of Medicare beneficiaries taking advantage of annual wellness visits, including recommended screenings and preventive care. The ACO also focuses on ensuring smooth patient transitions from the hospital to home—or a nursing home if needed. All ACO providers receive detailed information about their performance on quality measures, and clinicians and providers share best practices to coordinate the care beneficiaries receive from different primary care and specialty providers, and to prevent health issues and repeat hospitalizations. CAMC Health Network includes Charleston Area Medical Center, Thomas Memorial Hospital, Princeton Community Hospital, Roane General Hospital, Montgomery General Hospital, FamilyCare Health Centers, Coalfield Health Center, Hygeia Facilities Foundation, Cabin Creek Health Centers, Drs. Henry & Kinder, Pulmonary Associates, Charleston Nephrology Hypertension & Transplant, and Kanawha Nephrology, all of which serve central and southern West Virginia.
A market-based solution to fragmented and costly care, ACOs empower local physicians, hospitals and other providers to work together and take responsibility for improving quality, enhancing patient experience and keeping care affordable. The Medicare Shared Savings Program (MSSP) creates incentives for ACOs to invest in transformative care by allowing them to share in savings they generate after meeting defined quality and cost goals.
In 2020 nationally, 513 ACOs caring for 10.6 million beneficiaries participated in the MSSP, generating gross savings of $4.1 billion based on the Centers for Medicare & Medicaid Services methodology for setting financial benchmarks. After accounting for shared savings earned by ACOs in 2020, estimated net Medicare savings were over $1.9 billion.
“The Medicare ACO shared savings program is the largest value-based payment model in the country and a critical tool in moving the health system toward better value,” Coon said.