With its seven ACOs across five U.S. states and the District of Columbia, Prominence Health Plan continues to produce meaningful cost savings to Medicare, while providing value-based care to patients, and financial rewards to its participating physicians.
Reno, NV (October 18, 2022) — Prominence Health Plan, a subsidiary of Universal Health Services (NYSE: UHS), announces its 2021 Accountable Care Organization (ACO) results with more than $82 million in savings to Medicare and more than $56 million in earnings for its 3,000 participating physicians. This yields nearly $400 million in savings for patients since the establishment of the first UHS ACO in 2014.
"This success is an amazing testament to our providers’ commitment to their patients," said Kamal Jemmoua, CEO, Prominence Health Plan. "The growth we've seen this year has allowed us to create greater impact within the communities UHS serves. We are proud of our physician and provider partners, care management teams and support staff, who continue to focus on the quality of the patient experience and provide exceptional care."
ACOs are groups of physicians who agree to reduce costs and increase quality within a value-based contract, which results in a shared savings agreement. Physicians are incentivized and provided tools to bend the healthcare cost curve, manage utilization, and maintain high-quality care. This is due to both shifting from volume-based payments to value-based payments and better integrating data and communication between providers, patients, specialists, and hospital systems. Within the shared savings program, providers can earn back part of the savings they generate for Medicare by achieving pre-determined spending goals.
“The healthcare industry has been slow to transform away from fee-for-service, but value-based care and the ACO models have provided a guideline to focus on the delivery of high-quality patient care and outcomes within the primary care setting,” said Dr. Monzer Yazji, South Texas Clinical Partners ACO. “Primary care providers (PCPs) have realized they are at the center of value-based patient management and leadership. We continue to grow, learn and embrace the dynamics of preventative care and personalized medicine.”
Unlike the traditional ACO model, UHS ACOs are physician-led but sponsored either wholly by UHS or in a joint-venture partnership with ACO participants. These organizations are centered on primary care with community partnerships in post-acute and specialty care settings. Hospital sponsorship is a differentiator in UHS ACOs as the hospitals partner with providers to provide capital funding, invest in tools to better manage downside risk, and integrated ACO-friendly hospital initiatives focused on avoiding unnecessary utilization and increasing communication with ACO providers. The support from UHS facilities allows for ACO leadership and governance to be driven by participating providers in the community — a vital component to success in value-based care.
UHS also provides administrative oversight and data analytics for ACO operations in addition to ACO-friendly hospital initiatives within each UHS facility. These initiatives include PCP notification of ACO beneficiary admit/discharge, ACO patient flags within the hospital electronic medical record (EMR), partnerships with hospitalists and emergency department providers to ensure appropriate utilization, and integrated case management navigating PCP communication and post-acute care.
UHS ACO Highlights for 2021:
- Silver State ACO: Ranked #1 ACO in the state of Nevada for total savings at $34 million and achieved a savings rate at 7% below the benchmark
- California Clinical Partners ACO: Ranked #1 ACO in the state of California for total earnings at $21 million with a savings rate at 13% below the benchmark
- Texoma Clinical Partners: Ranked 2nd for highest quality score in the region
- South Texas Clinical Partners: Ranked in the top 5 in the state of Texas for savings rate at 9.5% below benchmark with $9.5 million in total savings
- DOC ACO: One of only 34 in the nation to achieve a 100% quality score
"Our patients are at the center of everything we do. Since launching in 2019, Texoma ACO has generated shared savings for three consecutive years, demonstrating a commitment from our primary care providers, partnered health system, and partnered post-acute network in practicing value-based medicine,” said Robert Sanders, MD, TexomaCare. “Our team is dedicated to shifting how medicine is practiced in our community from reactive to preventive medicine to improve the patient experience and reduce the financial burden of care to Medicare.”
The Center for Medicare and Medicaid Services (CMS) established the ACO program to improve the quality of care for Medicare beneficiaries and lower Medicare costs. If an ACO achieves high quality and saves money for Medicare, then the ACO shares in those savings. Since the beginning of the ACO program in 2013, [all or UHS?] ACOs have saved Medicare $6.8 billion.
About Prominence Health Plan
Prominence Health Plan began in 1993 as a health maintenance organization (HMO) and became a subsidiary of Universal Health Services, Inc. (UHS) in 2014. They provide coverage to Commercial (fully insured and self-funded), and Medicare Advantage members throughout Nevada and parts of Texas and Florida.
Prominence operates seven Accountable Care Organizations (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, our annual revenues were approximately $12.6 billion in 2021. In 2022, UHS was again recognized as one of the World’s Most Admired Companies by Fortune; ranked #297 on the Fortune 500; and in 2021 ranked #307 on Forbes’ list of America’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 28 acute care hospitals, 335 behavioral health facilities, 40 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).