The accountable care organization tied to Independent Physicians Network, Inc. once again was the top ACO in the state, according to new federal data.
It’s one of the four ACOs that will get a cut of the money saved from Medicare under a program experimenting with new payment models. The ACO program, which kicked off in 2012, is an effort from the feds to move Medicare away from a fee-for-service model that critics say has driven up the costs of health care.
Instead, those ACOs get rewarded if they keep costs down, though some might end up losing money if their costs come in above the benchmark.
Nationally, the Center for Medicare and Medicaid Services says ACOs saved Medicare $466 million last year. In Wisconsin, the costs were actually nearly $10 million higher than the benchmarks, though the state’s 11 ACOs last year had quality scores much higher than the national average.
The average national quality rating from Medicare’s shared savings program, the most popular ACO category, was 91.44 percent. Wisconsin ACOs, meanwhile, had an average quality rating of 94.92 percent, and none of them was below 90 percent.
The state’s top-performing ACO, an organization called the Accountable Care Coalition of Southeast Wisconsin, saved Medicare $17 million last year and will get nearly $8 million of those savings. The ACO is a partnership between the Milwaukee-based Independent Physicians Network and the national company Collaborative Health Systems, which helps run 24 ACOs across the country.
“We’re pleased,” said Mike Repka, the executive director and CEO at Independent Physicians Network. “We hope that we continue to do well each and every year.”
Among the benefits an ACO offers is giving providers access to any claims from Medicare beneficiaries. That means that they’re able to see whether a retiree who spends half of their time in Florida accessed medical care outside of their walls.
“It’s great to have the full picture of claims with detailed clinical data on what happened around the patient’s care,” said Patrick Falvey, the chief transformation officer at Aurora Health Care.
Aurora’s ACO was another that will reap the benefits of providing care at a cost lower than the benchmark. It saved Medicare about $5.5 million, and the ACO will get about $2.5 million back.
It’s the first year the ACO is receiving savings, which Falvey said is because the ACO “really engaged our physicians and our caregivers.” That includes, he said, ensuring their home health nurses are more involved throughout their patients’ care and follow up consistently with patients.
The multi-state ACO USMM Accountable Care Partners also is getting $7.3 million for saving Medicare $15 million last year. And Waukesha’s ProHealth Solutions is getting $2 million after saving the program nearly $4.5 million last year.
Peter Bacon, ProHealth’s chief business development officer, said leadership set clear targets and physicians and staff worked continually to meet them. The organization has also implemented several changes, such as educating patients on which post-acute facilities are the highest quality.
It also has committed to ensuring it reduces inpatient stays and instead focuses on cheaper outpatient care.
“We’re lowering our revenues doing these programs, but we’ve got a strong belief that we all have to do our part to lower medical costs,” Bacon said.
Other ACOs either didn’t save Medicare enough to share in the savings or ended up with costs above the benchmark. That includes Marshfield Clinic’s ACO, which cost $15.4 million more than its benchmark, and the UnityPoint Health ACO, which cost $10 million more.
Costs for the UW Health ACO were also nearly $6 million above its benchmark, though it had the second highest quality rating at 97.47 percent.
“We’re excited that we continue to demonstrate and show sustained excellence in providing high quality care and having low costs for patients,” said Jeff Huebner, the UW Health ACO medical director.
All of the state’s ACOs last year were participating in the first track of the shared savings program, so they won’t actually lose any money for having higher-than-expected costs.
Huebner said it’s a “challenge to beat the benchmark” for many Wisconsin ACOs because they are already providing high quality costs at a low care. But the ACO, he said, has made several system improvements that “will pay off in the long term,” such as ensuring health professionals better coordinate on patients’ care.
The UW Health ACO, like its peers, is considering a move to other types of Medicare ACOs that have different structures. That includes the Next Generation ACO model, which ThedaCare and Bellin Health Partners are jointly trying out this year.
CMS Administrator Andy Slavitt said it takes time for many ACOs to perform well, though he said “the longer you’re an ACO, the better you do.”
For their part, Wisconsin ACO leaders agreed.
“We’re not only learning new approaches and being innovative … but you hone your skills and you improve your processes,” Aurora’s Falvey said.
— By Polo Rocha,