Seven sponsored Medicare Shared Savings programs deliver high quality and demonstrate significant savings
RENO, NV (November 20, 2019) — Prominence Health Plan, a subsidiary of Universal Health Services (UHS), announced the 2018 results of its seven UHS Accountable Care Organizations (ACOs) showing a continued trend of increased cost savings and improved quality. In 2018, the ACOs saved Medicare $65.2 million, earning $30 million for its 3,000 participating physicians. Since the establishment of the first UHS ACO in 2014, the entities have saved more than $113M and averaged a 96% quality score.
ACOs are groups of physicians who agree to reduce costs and increase quality within a value-based contract, which results in a shared savings agreement. Physicians are incentivized to bend the healthcare cost curve, manage utilization and maintain high quality care by shifting from volume-based payments to value-based payments. Within the shared savings program, providers can earn back part of the savings they generate for Medicare by hitting pre-determined spending goals.
“The ACO concept is changing the way primary care medicine is being practiced in the United States, a change long overdue,” said Kamal Jemmoua, CEO, Prominence Health Plan. “This success is the outcome of intentional partnership within UHS communities, empowering local primary care clinicians with the necessary data and resources to provide high quality, high-value care. The model rewards both the patient and physician as the patient receives better healthcare and the physician is financially incentivized for keeping them as healthy as possible.”
UHS ACO Highlights:
- Silver State ACO in Nevada: Ranked first in the state for program savings with $33.9 million, ranked in the top 2% nationally.
- Texas Panhandle Clinical Partners: Ranked sixth out of 53 ACOs in the state of Texas for savings rate and brought in $13 million in program savings to rank in the top 7% nationally.
- South Texas Clinical Partners: Ranked 10th in the state in program savings at $11.4 million, the highest total savings compared to market competition, with a 100% quality score.
- GW Health Network: Ranked first of nine ACOs in the DC area in savings rate with a total program savings of $3.3 million, with a 100% quality score.
UHS ACOs are physician-led and hospital-sponsored, centered on primary care with community partnership in post-acute and specialty care. Hospital sponsorship is a differentiator in UHS ACOs as the hospitals provide capital funding, partnership in downside risk, and integrated ACO-friendly hospital initiatives focused on avoiding unnecessary utilization and increasing communication with ACO providers. The support from UHS facilities allows for ACO leadership and governance to be driven by participating providers in the community — a vital component to success in value-based care.
“The ACO has encouraged our providers to focus on specific high-value activities for our patients, as well as consider non-traditional social and environmental factors when addressing their overall care,” said Robert Sanders, MD, TexomaCare. “This process has improved the quality of care all of our patients receive.”
UHS also provides administrative oversight and data analytics for ACO operations in addition to ACO-friendly hospital initiatives within each UHS facility. These initiatives include PCP notification of ACO beneficiary admit/discharge, ACO patient flags within the hospital EMR, partnerships with hospitalists and ED providers to ensure appropriate utilization, and integrated case management navigating PCP communication and post-acute care.
The Center for Medicare and Medicaid Services established the ACO program to improve the quality of care for Medicare beneficiaries and lower Medicare costs. If an ACO achieves high quality and saves money for Medicare, then the ACO shares in those savings. Since the beginning of the ACO program in 2013, ACOs have saved Medicare $2.66 billion.
About Prominence Health Plan
Prominence Health Plan began in 1993 as a health maintenance organization (HMO) and became of a subsidiary of Universal Health Services, Inc. (UHS) in 2014. Prominence provides coverage to more than 60,000 fully-insured, self-funded and Medicare Advantage members throughout Nevada and parts of Texas. Prominence operates seven Accountable Care Organizations (ACOs) in California, Florida, Nevada, South Carolina, Texas and Washington D.C., which are managed care systems that benefit communities by providing coordinated, high-quality care to Medicare patients. For more information about Prominence Health Plan, visit ProminenceHealthPlan.com or ProminenceMedicare.com.
About Universal Health Services
One of the nation’s largest and most respected providers of hospital and healthcare services, Universal Health Services, Inc. (NYSE: UHS) has built an impressive record of achievement and performance. Growing steadily since our inception into an esteemed Fortune 500 corporation, our annual revenues were $10.77 billion during 2018. In 2019, UHS was again recognized as one of the World’s Most Admired Companies by Fortune; ranked #293 on the Fortune 500; and in 2017, listed #275 in Forbes inaugural ranking of America’s Top 500 Public Companies.
Our operating philosophy is as effective today as it was 40 years ago, enabling us to provide compassionate care to our patients and their loved ones. Our strategy includes building or acquiring high quality hospitals in rapidly growing markets, investing in the people and equipment needed to allow each facility to thrive, and becoming the leading healthcare provider in each community we serve.
Headquartered in King of Prussia, PA, UHS has more than 87,000 employees and through its subsidiaries currently operates 26 acute care hospitals, 328 behavioral health facilities, 40 outpatient facilities and ambulatory care access points, an insurance offering, a physician network and various related services located in 37 U.S. states, Washington, D.C., Puerto Rico and the United Kingdom. It acts as the advisor to Universal Health Realty Income Trust, a real estate investment trust (NYSE:UHT). For additional information on the Company, visit our web site: www.uhsinc.com.