Premier’s Population Health Management Collaborative ACOs Achieve Record Savings

Key Takeaways:

• A comprehensive population health strategy supports success in value-based care (VBC) models and significant benefits for patients, providers and the healthcare system as a whole.
• Premier’s Population Health Management Collaborative (PHMC) members achieved record Medicare Shared Savings Program savings in 2023, outperforming the national average for all ACOs and earning over $302 million in performance payments.
• Premier’s PHMC Collaborative, advisory services, advocacy efforts, and data and technology solutions help providers accelerate the transition to VBC.

The healthcare industry is amid a significant shift towards value-based care (VBC) and payment models – creating significant strategic, clinical and administrative challenges and opportunities for hospitals, health systems and provider groups.

Recently, the Centers for Medicare & Medicaid Services (CMS) announced that Medicare Shared Savings Program (MSSP) Accountable Care Organizations (ACOs) achieved more than $2.1 billion in net savings to Medicare in Performance Year (PY) 2023. This marks the most successful year in the history of the MSSP.

Premier’s Population Health Management Collaborative (PHMC) members consistently outperform the nation in total cost of care models. For PY 2023:

• A record number of PHMC members achieved shared savings, outperforming the national average for all ACOs. This equates to more than $302 million in performance payments for PHMC members.
• PHMC members earned shared savings at a higher rate than other hospital/health system (high revenue) ACOs, 71 percent compared to 58 percent for non-PHMC member (high revenue) ACOs.
• Overall, PHMC members generated more than $620 million for Medicare.

Across the board, MSSP ACOs earned a record $3.1 billion in shared savings payments – the highest since the program’s inception over a decade ago.

Accelerating the Transition to Value: Three Keys to Success

Succeeding within VBC models can be challenging, but PHMC member results show that a shared mission, effective collaboration, peer-to-peer benchmarking and data-driven performance improvement can help some make the transition faster, with higher-quality outcomes.

One key to successful participation in a Medicare ACO model is having a detailed understanding of the model and strategic planning services to ensure organizations can maximize opportunities for success in Medicare ACO programs. An example of such services includes Premier’s 2025 MSSP renewal/early renewal analysis and strategy projects that recently concluded. Through this work, Premier partnered with 20+ organizations to provide actuarial analyses and projections of performance for a 2025 MSSP agreement. These quantitative insights paired with Premier’s qualitative guidance help ACOs best position themselves for success in future years.

Actionable data is a second key to success as well as ensuring complete, accurate documentation and coding for reporting and reimbursement. Leveraging Premier’s Stanson Health HCC clinical decision support (CDS) solution helps provide ACOs an integrated approach to clinical documentation – improving the accuracy of disease burden documentation and offering a comprehensive suite of best practice alerts.

Many PHMC members have paired the capabilities of Stanson Health’s HCC CDS with the PHMC’s claims data analytics and benchmarking solution to create robust opportunity identification and performance improvement capabilities. And many have recognized significant performance and quality improvements in value-based payment agreements since implementing the solution.

Additionally, ACOs need a strong voice in advocating for the appropriate legislative and regulatory changes to the models to ensure they are positioned for success. Premier’s Washington, D.C.-based Advocacy Team supports PHMC members through regulatory feedback and interpretation along with legislative outreach.

A critical issue on the horizon is the looming expiration of eligibility for MSSP and other Advanced Alternative Payment Model (APM) payment incentives at the end of this year. Premier is fighting to secure a two-year extension of these essential incentives, giving ACOs the time and resources they need to thrive. Premier is also pressing for improvements to the MSSP to further support ACOs’ success, such as removing the high-low revenue distinction and modifying the thresholds to qualify for the incentive payments.

Most recently, CMS finalized policies for MSSP in the CY 2025 Physician Fee Schedule, including adopting some of Premier’s key recommendations to establish a more adequate transition to the new MSSP electronic quality reporting requirements.

At a time when some continue to question VBC success, ACOs and PHMC members underscore the transformative impact of population health in delivering high-quality, cost-effective healthcare for patients and communities:

“Our participation in the PHMC has greatly enriched our insight into opportunities for improving patient care. Assessment services and advanced tools provided, such as Stanson’s HCC coding support, have been instrumental in fostering appropriate care practices and ensuring comprehensive documentation. Moreover, the expertise and support from Premier’s dedicated team have been invaluable in guiding us through essential contracting decisions. We are truly grateful for the partnership and impact they’ve made on our work.” – Naomi Wedin, Executive Director, Bellin Health Partners and Chris Elfner, Vice President of Accountable Care, Emplify Health ($7.48m in Shared Savings)

“There are many services we rely on from Premier, including Premier’s expertise in the use and evaluation of our data – and how to best drill into the data and understand it in the context of the MSSP program. We appreciate the 1:1 data review meetings where we set the agenda and identify our concerns and questions, and Premier supports us in developing actions to improve our performance. Shared savings in MSSP is challenging to predict through the year and 2023 was especially challenging with the anomalous billing concerns. Premier worked with us to model multiple scenarios, which we felt confident to present to our MSSP leadership. It’s also helpful to participate in PHMC webinars and meetings with open, transparent conversations among other Collaborative members. Additionally, Premier’s advocacy is key as we are confident in their support of MSSP participants and their relaying program details to us. We support and encourage other ACOs to join the PHMC. Participating in the Collaborative brings education, support and advocacy, all of which are important to success in value-based performance.” – Chris Lewis, Executive Director, St. Luke’s Care Network ($15.6m in shared savings)

“Southeastern Health Partners has been participating in the MSSP since 2017 and has grown as an ACO greatly during this journey. We attribute a great deal of our success to the partnership with Premier and the PHMC as they’ve helped us analyze future direction, decisions and successes. Premier provides many opportunities to participate and grow – from navigating the CMS application processes, developing strategies for specific programs and ongoing performance analysis. Premier offers numerous workgroups around quality submission, post-acute strategy, bundles, managed care contracting, to name a few – and we participate in national meetings, which have opened doors with other ACOs that are on this same journey, allowing us to build relationships and share best practices. Premier’s analytics capabilities and expertise have also been valuable to our organization, pinpointing specific performance and opportunities. Lastly, I would call out Premier as a true, dedicated partner to help us navigate this complex journey of value-based care. Our success truly comes from this partnership and their support.” – Keith Newnam, Chief Executive Officer, Southeastern Health Partners ($5.46m in Shared Savings)

Investing in a comprehensive population health strategy and capabilities leads to significant benefits for patients, providers and the healthcare system as a whole. Alongside increased market competition, ongoing movement away from acute care settings, margin compression and CMS’ push to have all patients in an accountable relationship, now is the time to act.

To support the continued evolution of VBC and help future-proof our members, Premier formed its value-based care/population health team in 2010. Named Best In KLAS in Value-based Care Consulting for the past three years, this team leverages a unique approach of collaboratives, consulting and technology to meets providers where they are on their journey to population health – supporting over 100 organizations with strategy, operations and performance improvement initiatives.

With a framework for implementing successful population health models across payers, the PHMC offers comprehensive strategy, education and best-practice sharing, analytics and benchmarking services that work in concert to guide members on their transition from volume to value. Regardless of an organization’s progress on the journey, Premier can provide the data, insights and advisory expertise necessary to continue advancing.

If you and your organization are interested in learning more about how Premier, the PHMC and our advisory team can support your journey to VBC and population health management, contact Seth Edwards (seth_edwards@premierinc.com) or Richard Doane (richard_doane@premierinc.com).

Learn More:

• See how Premier’s Collaboratives, technology and advisory services can support your VBC and performance improvement efforts.
• Explore key healthcare data and technology challenges and discover specific steps to position your organization as a leader in the value revolution.