2021 ACO Success | October 2022 | News Flash

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October 21, 2022

 

McLaren ACO generates $5.4 million in savings in 2021.

 

McLaren High Performance Network, LLC (MHPN) is pleased to announce $5.4 million in savings for 2021 and this is our 5th consecutive year of generating savings.

 

2021 Performance Year- Key Statistics:

 

  • MHPN is ranked 2nd in Michigan in savings generated and 5th in savings per beneficiary, which increased 38% over 2020.
  • Only 54% of Michigan ACO’s generated savings, down from 80% in 2020.
  • Significant opportunities still exist for reducing utilization:
    • Inpatient Admissions
    • Skilled Nursing Facility (SNF)
    • ED visits

     

MHPN 5 Year Totals:

 

  • Generated savings = $ 84.1 million
  • Earned Savings = $33.8 million

 

Key Areas of Focus:

  • 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.

 

  • 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.

 

  • 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.

 

  • 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.

 

  • 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 michael.ziccardi@mclaren.org or (248) 484-4923.