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In performance year 2021, 563 accountable care organizations (MSSP and NGACO ACOs), and Direct Contracting Entities (DCEs) generated more than $3.9 billion in total savings by improving care coordination and focusing on providing high-quality, more efficient care. Despite ongoing challenges with record labor shortages, unprecedented margin pressures and the COVID-19 pandemic, PINC AI™ Population Health Management Collaborative (PHMC) member ACOs and DCEs outperformed national ACOs and DCEs in generating savings and shared savings for the seventh year in 2021.
In 2021, Premier’s PHMC ACOs and DCEs included over 50 health systems, which have formed 53 Medicare Shared Savings Program (MSSP) ACOs, five Next Generation ACOs, and one Global and Professional Direct Contracting entity. Together, these ACOs and DCEs include over 100 hospitals and thousands of clinicians working together to align, measure and share best practices and improve population health management.
During the pandemic, a 2020 Premier survey found that providers in ACOs and other alternative payment models (APMs) utilized advanced population health and value-based care capabilities to navigate the COVID-19 pandemic by managing care in the community and sustaining revenue streams outside of fee-for-service reimbursement. In performance year 2021*, PHMC members continued to prove that establishing a well-planned value-based care delivery process and model can lead to success:
Results like these accomplished by Premier’s PHMC ACOs and DCEs reinforce the value of participation in value-based care and how it is essential in helping providers deliver high-quality care at lower costs. According to a recent survey, 67 percent of providers indicated value-based care is better at providing high-quality care to patients than other models. Many studies have shown that value-based care prevents hospital readmissions and reduces emergency department visits. These prevention efforts lead to more affordable care for all.
Additionally, hospitals and health systems are facing unprecedented financial pressures. These results are indicative of the paradigm shift many organizations are considering as they leverage population health to alleviate margin pressures, while positioning the health system for future reimbursement models. Through population management, health systems can help ensure their patients receive the right care, at the right place, at the right time.
Recognizing the success of ACOs and DCEs at improving quality while lowering costs, the Centers for Medicare & Medicaid Services (CMS) set a goal of moving all Medicare fee-for-service beneficiaries into an accountable care relationship by 2030. To accomplish this, Congress and CMS should adopt new policies and flexibilities that will help strengthen and increase participation in the MSSP and other value-based care programs. In Premier’s opinion, these should include:
It’s important to note that ACOs and other APMs incentivize providers to work together with aligned incentives focused on ensuring patients receive the right care at the right time. Rather than individual providers being responsible only for the treatments and services they themselves provide, groups of clinicians and other providers in the community are, together, focused on and responsible for the quality, wellness and total cost of care.
Premier plans to continue efforts to advocate for ACOs and help providers hone their strategies for success in all Medicare fee-for-service, network level, total cost of care models (MSSP, ACO REACH).
*Methodology: Comparative analysis completed using an internal roster of Premier's Population Health Management Collaborative Advanced members and the publicly available results files for performance year 2021 from the Medicare Shared Savings Program, Next Generation ACO Model, and the Global/Professional Direct Contracting Model.
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