Continues to produce meaningful cost savings while providing value-based care to patients, and financial rewards to participating physicians
RENO, NV (Nov. 3, 2021) — Prominence Health Plan, a subsidiary of Universal Health Services (NYSE: UHS), reports that in 2020, its seven Accountable Care Organizations (ACOs) combined to save Medicare $84.7 million, resulting in over $50 million in earnings for its 3,000 participating physicians and an average quality score of 98%.
These savings are in line with those in 2019, when the ACOs saved Medicare $90 million and shared $40 million with the same number of participants.
UHS first entered the Medicare Shared Saving Program in 2014. Since then, its ACOs have collectively saved Medicare nearly $300 million and earned performance payments of $108 million. During this period, they also maintained an average quality score of 97%, demonstrating UHS ACOs are effectively lowering health care costs, while delivering high-quality, coordinated care for its Medicare beneficiaries.
“UHS is proud to work with such dedicated physicians and their practices,” said Kamal Jemmoua, CEO of Prominence Health Plan, which provides administrative support for the ACO programs. “This success reflects the physician-driven strategies our team has designed to provide high-quality, high-value care. While we’ve achieved significant savings, we’ve also meaningfully enhanced the quality of care delivered to patients.”
ACOs are groups of physicians, hospitals and other health care providers who agree to reduce costs and increase quality within a value-based contract. Participants are incentivized to alter the healthcare cost curve, manage utilization, and maintain high quality care by shifting from volume-based payments to value-based payments. Within the shared savings program, providers can earn back part of the savings they generate for Medicare by achieving pre-determined spending goals.
UHS ACOs are physician-led and sponsored either wholly by UHS or in a joint-venture partnership with ACO participants, depending on the structure of the ACO. They focus on primary care with community partnership in post-acute and specialty care.
“Value-based care models that are set up to bring health system resources to physician-led ACOs are the future of health care. Any provider not yet in a value-based care model would do well to begin that transition and establish value-based care as the foundation of their practice,” said Dr. Monzer Yazji, South Texas Clinical Partners ACO. “The path to ACO success involves years of work as we learn to maximize our efforts as a healthcare team. This partnership results not just in shared savings, but also high-quality patient care at an efficient cost in our community.”
UHS ACO Highlights:
- Silver State ACO: Ranked #1 ACO in the state of Nevada for total savings at $44 million and for savings rate at 8% below the benchmark
- California Clinical Partners ACO: Ranked 2nd in California for earned savings at $11 million
- Texoma Clinical Partners: Ranked highest quality score in the region at 99%
- South Texas Clinical Partners: Ranked Top 5 in the state of Texas and 2nd in the Rio Grande Valley for savings rate at 9% below benchmark with $9.5 million in total savings
- Texas Panhandle Clinical Partners: Ranked highest quality score in the region at 98%
- GW Health Network: Ranked 2nd in the DC area for savings rate at 7% below the benchmark with a total program savings of $4.6 million
- DocACO: Ranked highest quality score in the region at 99%
Unlike other ACOs, those established by UHS may have a hospital affiliation to provide capital funding, and partner in any downside risk. The support from UHS facilities allows for added benefit of ACO leadership and governance to be driven by participating providers in the community.
UHS also provides administrative oversight and data analytics for its ACO operations as well as hospital initiatives focused on reducing unnecessary utilization and increasing communication. These initiatives may include PCP notification of ACO beneficiary admit/discharge, ACO patient flags within the hospital EMR, partnerships with hospitalists and ED providers to ensure appropriate utilization, and integrated case management navigating PCP communication and post-acute care.
"Texoma Clinical Partners ACO is very fortunate to have a robust care team in place to address social needs, provide disease coaching, and coordinate care with other clinicians," said Robert Sanders, MD, TexomaCare. “The transformative work led by clinicians who engaged our office staff, hospitals, and acute facilities resulted in a 99% quality score, which is higher than the MSSP national average, while successfully reducing cost to the Medicare trust fund.”
The Center for Medicare and Medicaid Services (CMS) established the ACO program in 2013 to improve the quality of care for Medicare beneficiaries and lower Medicare costs. Currently more than 12.1 million Medicare-fee-for-service beneficiaries receive care from a Medicare ACO healthcare provider.
According to CMS, those ACOs in Medicare Shared Savings Program earned performance payments of nearly $2.3 billion in 2020, while saving Medicare $1.9 billion. This marks the fourth consecutive year of net savings for Medicare. According to National Association of ACOs, these entities had an average quality score of 97.8 out of 100.
About Prominence Health Plan
Prominence Health Plan began in 1993 as a health maintenance organization (HMO) and became of a subsidiary of Universal Health Services, Inc. (UHS) in 2014. They provide coverage to fully insured, self-funded and Medicare Advantage members in Florida, Nevada, and Texas.
Prominence operates seven ACOs in California, Florida, Nevada, South Carolina, Texas and Washington D.C., which are managed care systems that benefit communities by providing coordinated, high-quality care to Medicare patients. For more information about Prominence Health Plan, visit ProminenceHealthPlan.com or ProminenceMedicare.com.
About Universal Health Services
One of the nation’s largest and most respected providers of hospital and healthcare services, Universal Health Services, Inc. has built an impressive record of achievement and performance. Growing steadily since our inception into an esteemed Fortune 500 corporation, annual revenues were $11.6 billion for 2020. In 2021, UHS was again recognized as one of the World’s Most Admired Companies by Fortune; ranked #270 on the Fortune 500; and listed #307 in Forbes ranking of U.S.’ Largest Public Companies.
Our operating philosophy is as effective today as it was upon the Company’s founding in 1979, enabling us to provide compassionate care to our patients and their loved ones. Our strategy includes building or acquiring high quality hospitals in rapidly growing markets, investing in the people and equipment needed to allow each facility to thrive, and becoming the leading healthcare provider in each community we serve.
Headquartered in King of Prussia, PA, UHS has approximately 89,000 employees and through its subsidiaries operates 26 acute care hospitals, 335 behavioral health facilities, 39 outpatient facilities and ambulatory care access points, an insurance offering, a physician network and various related services located in 39 U.S. states, Washington, D.C., Puerto Rico and the United Kingdom. It acts as the advisor to Universal Health Realty Income Trust, a real estate investment trust (NYSE: UHT).