November 11, 2022
MHPN to distribute $3.1 million to ACO providers
McLaren High Performance Network, LLC (MHPN) is pleased to announce the release of the provider distribution of the 2021 ACO shared savings to our ACO member providers. 2021 was our 5th consecutive year of generating savings, MHPN Savings per Beneficiary increased 38% over 2020.
The payout will consist of utilizing the Board approved methodologies based on performance of participating providers on population health related metrics, Medicare Beneficiary Attribution and Provider Risk Adjusted financial performance on cost compared to the CMS benchmark.
Independent PCP and Specialist payments will be made to the current Tax ID on file.
MMG (employed) PCP and Specialist payments will be forwarded to MMG.
Improving performance on the following measures will increase your clinical and utilization performance which may result in an increased financial distribution.
1. Transitions of Care visits (TOC/TCM):
- A visit to the PCP within 7-days of discharge, remains critical to the coordination of care a patient must receive to support a patient’s return to health and to help reduce unnecessary utilization, readmissions and spend during this critical recovery period.
2. HCC Coding:
- Proper HCC coding by our providers to more accurately document and code a beneficiary’s medical conditions funds the severity of care the patient needs by CMS to the ACO.
- This helps to increase the benchmark target amounts set by CMS against which our performance is measured.
3. Risk- Adjusted Financial Performance:
- An individual provider’s risk adjusted PBPY compared to the ACO benchmark. If spending is below the benchmark, the provider has contributed to the overall savings and is eligible to receive a portion of the shared savings distribution.
4. Care Coordination:
- Management of the chronic medical conditions of the high need/high-cost patients.
- Providing outreach and management to those patients with stable chronic conditions before an acute episode occurs.
- Refer patients to the MPP Care Coordination team to coordinate, secure additional resources and support patient compliance with your care plan.
5. Annual Wellness Visits (AWV):
- These visits are a great opportunity for a health care provider to assess a beneficiary’s risk and provide self-management education.
- Providing an AWV plays a key role in beneficiary assignment to our ACO, as this may be the only Primary Care visit a healthy Medicare Beneficiary has in a calendar year.
- MHPN can provide a list of your prospective Medicare members who are eligible for an AWV.
The MSSP ACO contract is our largest value-based contract at McLaren. Fee schedules for many payers are frozen, similarly, CMS has no physician fee schedule increases planned for the foreseeable future in the MIPS program. Value-Based Payments from Value-Based Contracts like these will continue to be the way physicians, hospitals and health systems receive additional funding going forward.
For more information or to discuss joining our ACO please contact me at [email protected] or (248) 484-4923.