Seven sponsored Medicare Shared Savings programs deliver high quality and demonstrate significant savings
RENO, NV (December 3, 2020) — Prominence Health Plan, a subsidiary of Universal Health Services (UHS), announced the 2019 results of its seven UHS Accountable Care Organizations (ACOs) showing a continued trend of increased cost savings and improved quality. In 2019, the ACOs saved Medicare $90 million, earning $40 million for its 3,000 participating physicians. The savings increased by nearly 40% compared to 2018 due to continued improvement in value-based care delivery by participating ACO providers, as well as through expansion of the ACO programs to new markets. Since the establishment of the first UHS ACO in 2014, the entities have saved more than $207M and averaged a 97% quality score.
“This continued success is due to intentional partnerships within UHS communities, empowering local primary care clinicians with the necessary data and resources to provide high quality, high-value care,” said Kamal Jemmoua, CEO, Prominence Health Plan. “The model rewards both the patient and physician as the patient receives better healthcare and the physician is financially incentivized for keeping them as healthy as possible.”
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 to bend 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 hitting 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. The ACOs are focused on primary care with community partnership in post-acute and specialty care.
“Value-based care models are both the present and the future of health care. Any provider not yet in a value-based care model would do well to 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 transformative work led by clinicians engaging office staff, hospitals, and post-acute facilities 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:
- California Clinical Partners ACO: Partial year ACO opened in July 2019, ranked 1st in the California 2019A cohort for total savings at $5.1 million.
- Silver State ACO in Nevada: Ranked 1st in the state for both total savings at $48 million and for savings rate at 10% below benchmark; ranked in the top 1% nationally for total savings.
- Texoma Clinical Partners: Partial year ACO opened in July 2019, ranked 8th in the Texas 2019A cohort for total savings at $5M and ranked 5th in the state for savings rate at 5% below benchmark.
- South Texas Clinical Partners: Ranked in the top 10% nationally for total savings and in the top 3% nationally for savings rate. Ranked 8th in state for total savings at $14.8M and 2nd in the state for savings rate at 12% below the benchmark.
- GW Health Network: Ranked 1st in the DC area for savings rate at 8% below the benchmark with a total program savings of $6 million.
“Participating in Texoma Clinical Partners ACO has afforded our providers the data and support needed to extend their care beyond the walls of their practice,” said Robert Sanders, MD, TexomaCare. “We are no longer limited to the care we can single handedly deliver in our practices, and can now utilize a patient centered holistic approach to impact our patients at any physical location.”
Hospital sponsorship is a differentiator in UHS ACOs as the hospitals partner with participants to provide capital funding, partnership in 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.
“ACO initiatives require dedicated effort and time, which can be challenging for busy clinicians. The goal is to help each other keep line of sight on the long-term vision and the corresponding rewards,” said Dr. Luis Benavides, South Texas Clinical Partners ACO. “Participating in the MSSP has improved patient care because providers are incentivized to keep their patients healthy. Because of the aligned financial incentives, your income level as a clinician can remain the same even though you are now spending more time with each patient. If you build the right team around you, much of the documentation and supplemental efforts can be achieved by your staff while you as the physician are focused on caring for patients.”
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 EMR, partnerships with hospitalists and ED providers to ensure appropriate utilization, and integrated case management navigating PCP communication and post-acute care.
The Center for Medicare and Medicaid Services 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, ACOs have saved Medicare $5.2 billion.
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 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. Parent company UHS ranks 281 on the 2020 Forbes 500 list of America’s largest corporations and consistently ranks among Fortune’s list of the World’s Most Admired Companies.
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 $11.4 billion for 2019. In 2020, UHS was again recognized as one of the World’s Most Admired Companies by Fortune; ranked #281 on the Fortune 500; and listed #330 in Forbes ranking of U.S.’ Largest Public Companies.
Our operating philosophy is as effective today as it was 40 years ago, enabling us to provide high-quality care to our patients and their loved ones. Our strategy includes building or acquiring 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 90,000 employees and through its subsidiaries operates 26 acute care hospitals, 328 behavioral health facilities, 42 outpatient facilities and ambulatory care access points, an insurance offering, a physician network and various related services located in 37 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).