March 11, 2024 view online here (subscription required)
In addition to expanding health insurance coverage to millions of Americans, the 2010 Affordable Care Act spurred initiatives designed to slow the growth of the nation’s healthcare tab, in part by encouraging providers to do a better job coordinating care and eliminating care that provides little value.
One of these initiatives is the Medicare Shared Savings Program, which allows hospital systems and doctors’ groups, acting through an Accountable Care Organization (ACO), to earn bonuses if their patients with traditional Medicare cost less than government projections.
Top Medicare Shared Savings Programs Nationally
Two of the nation’s top-performing Medicare shared savings Accountable Care organizations in 2022, in bold, had patients in Southeastern Pennsylvania. The ACOs are ranked by the savings rate, which shows how much the ACO reduced expenses compared to a benchmark set by federal Medicare regulators. Shared savings, in millions, is the amount the ACO got to keep.
| States | ACO name | Patients | Savings rate | Shared savings |
|---|---|---|---|---|
| Florida, Minnesota, Wisconsin | Physicians ACO | 6,472 | 18.16% | $9.90 |
| Pennsylvania | PA MSSP PMA | 5,342 | 16.74% | $7.69 |
| Louisiana | LA MSSP 2016 | 14,816 | 15.10% | $19.28 |
| Pennsylvania, Ohio | PA MSSP Legacy + Gateway | 25,277 | 14.43% | $29.93 |
| California | Family Choice ACO | 9,201 | 14.31% | $12.39 |
Interest in the program is rising in the Philadelphia region.
Tandigm Health LLC, founded in 2014 by Independence Health Group to help independent primary care doctors manage care for Medicare Advantage patients, started a traditional Medicare ACO in 2022. The ACO, formed with Grand View Health, TriValley Primary Care, and Kuhar Medical, had 11,150 patients in 2022. It generated savings of 6.4%, and was able to keep $6.3 million for itself and the participating doctors.
Doylestown Health formed a Medicare shared savings ACO last year called Doylestown Value Partners, after splitting off from an ACO joint venture with Redeemer Health. Last year’s results are not yet available. Tandigm manages the ACO, which has 11,800 patients. Doylestown and Redeemer had been partners in Community Collaborative of Pennsylvania and New Jersey LLC.
Penn Medicine, which in December announced a preliminary agreement to acquire Doylestown Health, started a new Medicare shared savings ACO this year with 32,000 patients. The move came after Penn paid $50 million at the beginning of last year for a stake in Tandigm, which will manage the ACO.
Aledade has two new ACOs this year with strong Philadelphia-area ties. One is for community health centers throughout Pennsylvania, and includes the largest federally qualified health centers in Southeastern Pennsylvania. It also formed one with Advocare LLC, a large physician group in Marlton with offices in Pennsylvania and New Jersey.
Philadelphia-Area Medicare Shared Savings ACOs
The ACOs are ranked by their 2022 savings rate, which shows how much the ACO reduced health care expenses compared to a benchmark set by federal Medicare regulators. Shared savings is the amount the ACO got to keep. Some organizers of the ACOs have changed.
Source: Centers for Medicare and Medicaid Services
| Organizer | ACO | Patients | Savings rate | Shared savings |
|---|---|---|---|---|
| Aledade | PA MSSP PMA | 5,342 | 16.74% | $7.69 |
| Aledade | PA MSSP Legacy + Gateway | 25,277 | 14.43% | $29.93 |
| Aledade | National MSSP 2019 | 8,665 | 7.50% | $3.45 |
| Capital Health | Capital Health ACO | 7,577 | 1.44% | $0.00 |
| Cooper Health | AllCare Health Alliance | 14,119 | 5.44% | $3.61 |
| Crozer Health | Crozer ACO | 8,723 | 7.37% | $5.68 |
| Jefferson Health | Einstein Care Partners | 8,782 | −1.08% | $0.00 |
| Jefferson Health, Main Line Health | Delaware Valley ACO | 78,520 | 3.20% | $21.78 |
| Redeemer Health, Doylestown Health | Community Care Collaborative | 30,006 | 4.16% | $10.09 |
| Tandigm Health | Tandigm Value Partners | 11,150 | 6.37% | $6.29 |
| Virtua | LHS Health Network | 8,660 | 0.99% | $0.00 |