2/ @AledadeACO is proud to be the largest, most successful nationwide enabler of physician-led ACOs, delivering better care at lower cost for >340,000 Medicare beneficiaries, saving Medicare and American taxpayers nearly $180 million in unnecessary health care spending last year!
3/ Here's the list of the physician-led ACOs we are supporting, and our performance data.
* It doesn't matter if you're urban, rural, suburban, or in which state
* It gets better. The longer you work, the more the chances of success
* More risk = Higher rewards
4/ Last year was also the first year of the new Pathways to Success program. Every single one of Aledade’s MSSP ACOs who switched to Pathways to Success (higher risk/ higher reward) achieved savings. Every single one!
8/ "The trauma of the pandemic has underscored the need for a resilient health care system where reimbursement is not tied to volume of services provided, but rather to value-based incentives to keep patients healthy"
(We @AledadeACO are growing like crazy in the midst of COVID)
9/ We can least afford to lose practices in rural areas that are often the only source of primary care, and supporting them is a particular source of pride for us.
3/ On the risk adjustment policy front, there was a technical problem
The update (2023 data predicting 2024 costs) included skyrocketing skin substitute costs. Since policy took those costs away after 2025, model needed to be redone to lower the weight given to eg skin ulcer Dx
1/ A new @CMSinnovates ACO model was released this week
In our interview with @AbeSutton on the #ACOshow I teased him about how every new CMMI director seems to believe the world needs yet another primary care model (instead of improving the #MSSP model)
Did he prove me wrong?
2/ He might have
Here's what the RFA says is the new model is testing- bear with me and we will walk through each one
1. Bringing in high cost providers 2. Benchmarking that avoids ratchets 3. High needs/duals patient 4. Specialist engagement fin model 5. Beneficiary incentives
3/ Growing ACO participation
MSSP winners have been more efficient physician-led practices (fewer specialist/procedures, less expensive hospital care)
The hypothesis is that if we can get high cost providers into ACOs, they can save more money.
1/ CMS released the "2027 Medicare Advantage and Part D Advance Notice" on Monday afternoon, and health plan stocks lost some $100B of market value?
What was so shocking?
Let's descend into policy weeds & make some predictions about Final Notice
(not investment advice obvsly)
2/ Here's the big components of this year's notice, compared to last year.
A 5 percentage point difference in payments is a BIG deal for a $500B industry currently nursing profit margins of 0-2%
(this does not include an expected 2.45% increase in payments from coding trend)
3/ The top part is actuarial math-
good or bad, most people ascribe political intent to it, but it's just what the independent green-eyed shade professionals estimate for trends in costs in Traditional Medicare
by law, that's what the MA plan rate increases are indexed to
1/ The 2024 Medicare Shared Savings Program results are released from embargo!
topline results:
10,326,340 bene-years (12% @AledadeACO )
$6,452,075,989 in savings versus benchmark
$4,062,804,612 in payments to ACOs (19% Aledade)
Largest savings ever
Higher quality than FFS🎉
2/ fact sheet:
$643 (2024) vs $515 (2023) in gross per capita savings
Almost 2x savings rate for "low revenue ACOs" (physician-led/FQHC/RHCs) and for those composed predominantly of primary care clinicians vs high revenue ACOs (typically hospital-led)
"lower utilization compared to their benchmark across many categories of utilization including hospital discharges, Emergency Department visits and Skilled Nursing Facility stays"
Better chronic disease management
More prevention
Less suffering