To be successful in the Medicare Shared Savings Program, a provider has to participate in value-based care across the health system. That's according to the chief medical officer of one that earned the third largest total savings in its third year in the program.
About a third of the 392 health systems in the Medicare Shared Savings Program earned payments, according to the Centers for Medicare and Medicaid Services, in announcing results Thursday.
Advocate Physician Partners Accountable Care Organization came in third, earning $72.6 million.
The Illinois ACO followed Memorial Hermann of Texas, which at number one, earned $89 million in savings; and the Palm Beach ACO at $76 million.
CMS determines the savings based on a number of factors, including the number of enrollees, charges, actual costs, and quality scores.
Advocate has close to 150,000 beneficiaries in its ACO, according to Chief Medical Officer Lee Sacks, MD. It earned a quality score of 94.
Advocate's clinical integration program goes back to 2003, Sacks said, when the provider began to focus on chronic diseases. The system became part of the Medicare Shared Savings Program in 2012.
Two years ago, Advocate created a behavioral health service line to reach patients who went to the emergency department seeking help.
The support structure uses telemedicine for an emergency consult with the psychiatrist or social worker. In some cases, Sacks said, patients sitting in the ER waiting for a bed have been able to go home stable.
Another factor, he said, was that back in 2010 after the passage of the Affordable Care Act, Advocate made the decision to go all-in on value-based care.
"We're approaching all our business this way," Sacks said. "Just trying to do Medicare Shared Savings, it's really hard to be successful."
For the first two years, Advocate was not successful, at least in achieving savings.
"You have to look at data and understand what the gaps are," Sacks said.
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Advocate got this year's preliminary results on July 31 and on Thursday got the official announcement from CMS.
The physician ACO shares its savings with Advocate Health Care.
The health system is considering whether to take the next step into savings and risk, through Next Generation.
Medicare accountable care organizations saved $466 million in 2015, according to Thursday's announcement from CMS.
Over 400 Medicare ACOs generated the $466 million in savings and of these, 125 qualified for shared savings payments by meeting quality performance standards, said Patrick Conway, MD, CMS principal deputy administrator and CMO.
Eighty-three ACOs had healthcare costs lower than their benchmark but did not qualify for shared savings, CMS said.
In 2015, Medicare ACOs included 392 Medicare Shared Savings Program participants and 12 Pioneer ACO model participants.
Collectively, Medicare Accountable Care Organizations have generated more than $1.29 billion in total Medicare savings since 2012.