By Helping Nearly a Million Patients Get Better Care, Aledade ACOs Have Saved More Than $400 Million in Wasteful Health Care Spending
New Medicare data show Aledade prevented 10,000 hospitalizations in 2019 as three-fourths of Aledade's MSSP ACOs earned shared savings
BETHESDA, Md., September 23, 2020 (Newswire.com) - Today, Aledade, Inc. announced that its accountable care organizations (ACOs) with commercial payers, Medicaid, Medicare Advantage, and the Medicare Shared Savings Program (MSSP) have saved more than $400 million across the health care system in five years by helping patients receive higher-quality care, with over half of that value created in the past year.
In 2019 alone, independent primary care practices in Aledade contracts with commercial and government payers saved more than $200 million in health care spending while delivering better care to more than 620,000 Americans. New data from the Centers for Medicare and Medicaid Services (CMS) show that, in 2019, Aledade’s MSSP ACOs prevented 10,000 hospitalizations for Medicare beneficiaries and saved Medicare more than $180 million in unnecessary health care spending. Nearly half of these savings were kept by CMS and the American taxpayer, and the majority ($55 million) of the remainder went directly to physician practices.
“Six years ago, we made a bold wager - that by empowering small, independent primary care practices you could change the face of health care,” said Farzad Mostashari, MD, CEO and co-founder of Aledade. “Those primary care practices are delivering on that promise. Thanks to years of hard work and collective effort, our nationwide network of hundreds of primary care practices has proven, across states and across payers, that you can reduce spending in health care and you can do it the right way: by helping patients stay healthy rather than waiting for them to get sick.”
By emphasizing prevention and expanding access to primary care services, every Aledade Medicare ACO achieved an average quality score of more than 90 percent for the year, with every single practice working with Aledade earning the “exceptional performance bonus” in the Merit-based Incentive Payment System. Aledade ACOs in Medicare Advantage have earned an average of 4 STARS, often making significant improvements. In North Carolina, for example, practices improved their Medicare Advantage STARS rating from 3.0 to 4.5 after just one year of working with Aledade.
These quality metrics reflect real-world improvements in patient care. For instance, the nearly 5,000 independent physicians practicing in Aledade’s Medicare ACOs in 2019 reduced patient stays in hospitals by an average of nine percent, avoiding more than 10,000 hospitalizations. Aledade Medicare ACOs increased primary care services by 7.5 percent between 2018 and 2019, leading to 90,000 more visits between patients and their primary care physician. With Aledade’s technology and on-the-ground support, patients of practices in Aledade ACOs received better blood pressure screening, A1C control, and rates of cancer screening. They got more flu shots, and finally got help quitting smoking.
These results, the 90,000 additional primary care visits, the more than 224,000 annual wellness visits, and the more than 17,000 transitional care management appointments, all mark the product of years of work by Aledade and its partner practices, resulting in best practices and workflow transformation insights that allow this model to be replicated across payers and in geographically diverse communities, to rapidly improve patient care and thereby earn shared savings.
Aledade ACOs are also proving that, with the right partner, value-based programs done right can produce impressive and accumulating results. Last year, every single one of Aledade’s ACOs that started in 2016 earned shared savings. This year, every single one of Aledade’s ACOs entering Medicare's brand new Pathways to Success program earned savings. Overall, more than 95 percent of ACOs in operation for three years earned shared savings.
Several of Aledade’s MSSP ACOs saw especially impressive results last year:
- As the MSSP program transitioned to its new “Pathways to Success” structure in 2019, Aledade successfully navigated the new rules to ensure that the growth of value-based care continued without interruption. In January 2019, Aledade launched a multi-state ACO, called Opportunity ACO, which allowed physicians in Alabama, Pennsylvania, Georgia, Kansas, South Carolina, Florida, North Carolina, West Virginia, Virginia, and Maryland to come together and get the benefits of joining an ACO as soon as possible for the 75,000 lives in their care. By working with Aledade, they beat CMS cost expectations by $34 million in 2019, earning the physicians and the ACO $17 million in shared savings.
- Aledade ACO physicians in Louisiana, who have worked with Aledade since 2016, increased their 2019 Medicare revenue by 47 percent, and they also significantly improved blood pressure control for their patients. Over 82 percent of those with hypertension under the care of these physicians have achieved satisfactory blood pressure control.
- Practices and community health centers in the Appalachia region generated $7 million more in savings than expected in 2019, in just their second year of participation.
- In Utah, the Aledade ACO earned a quality score of 99 percent while saving $7 million and increasing the Medicare revenue of the practices by 20 percent.
- Aledade’s Kansas Health Center ACO has already generated $2.7 million in savings after starting under the new Pathways to Success rules in July of 2019.
Aledade’s ACOs are creating a better experience for patients while lowering costs across the entire system. The results from 2019 show that, across the health care system, ACOs led by physicians, often called “low revenue,” typically create more than twice the Medicare savings per beneficiary than hospital-led ACOs, often known as “high revenue.” According to CMS data, in 2019, physician-led MSSP ACOs had gross per-beneficiary savings of $458 per beneficiary compared to $169 per beneficiary for hospital-led MSSP ACOs. Aledade MSSP ACOs had savings of $490 per beneficiary. In the new Pathways to Success program, physician-led ACOs had per-beneficiary savings of $429 while hospital-led ACOs had per-beneficiary savings of $258. Aledade ACOs had per-beneficiary savings of $663 in Pathways to Success.
These savings across Medicare and commercial contracts are supporting small and independent primary care practices across the country at a crucial moment. While lockdowns and social distancing measures have helped keep patients and primary care workers safe during the COVID-19 pandemic, the drastic reduction of in-person visits and the inability of telehealth to fully make up the difference put the finances of small, independent primary care practices in jeopardy. Primary care is traditionally the most underpaid specialty and many practices run on small margins with little in reserves.
At just this moment of financial stress, Aledade’s practices will be receiving more than $55 million in shared savings checks from Medicare for 2019, roughly $150,000 per practice on average, an amount equating to about 23 percent of their annual Medicare fee-for-service revenue. Aledade’s 15 commercial contracts will bring in an additional $16.5 million to more than 231 small, independent primary care practices in 15 states. These shared savings payments will provide a much-needed inflow of revenue to keep practice doors open and ensure physicians can serve their communities in this time of need.
Aledade’s Accountable Care Organization network has grown since its founding in 2014 and now covers more than 810,000 lives, or patients, across 46 Accountable Care Organizations in 26 states with more than 500 participating practices. In addition to rapidly expanding its value-based model to more communities, payers, and populations, Aledade is also leading the industry when it comes to accepting higher levels of financial risk. In 2020, 32 of Aledade’s 76 contracts are embracing risk, compared with 17 of 67 in 2019, and four of 31 in 2018.
Founded in 2014, Aledade partners with independent practices, health centers, and clinics to build and lead Accountable Care Organizations (ACOs) anchored in primary care. Through these ACOs, Aledade empowers physicians to stay independent, practice medicine like they’ve always wanted to, and thrive financially by keeping people healthy. Aledade offers a comprehensive range of capabilities that includes cutting-edge data analytics, user-friendly guided workflows, unparalleled regulatory expertise, strong payer relationships, and local, hands-on support from attentive experts. In true alignment with more than 7,300 participating providers in 26 states, Aledade shares in the risk and reward across over 76 value-based government and commercial contracts representing more than 810,000 lives under management. To learn more, visit www.aledade.com or follow on Twitter or Facebook.
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Source: Aledade, Inc.