What Collaborative Health Systems, athenahealth and Milliman Found, Sifting Through CMS ACO Performance Data

By Clive Riddle, October 22, 2021

Collaborative Health Systems has announced their affiliate Accountable Care Coalition (ACC) of Southeast Texas, Inc. generated nearly $64 million in shared savings under the Next Generation Accountable Care Organization (ACO) Model for performance years 2017 through 2020, according to CMS performance year 2020 data. CHS, reports that in 2020, the ACC of Southeast Texas achieved the following outcomes:

• Served more than 18,000 Medicare beneficiaries across southeast Texas;
• Achieved an overall savings rate of 12.2%, the third highest of all Next Generation ACOs; and,
• Generated $30 million in shared savings – a 70% increase from performance year 2019.
• Achieve a 94.6% overall quality score
• The network has experienced a 20% decrease in inpatient discharges per 1,000 and a 29% decrease in ER visits per 1,000 since 2012.

The Accountable Care Coalition of Southeast Texas has participated in the Next Generation ACO initiative since the program's first performance year in 2016. Performance year 2021 represents that last year of the Next Generation ACO Model. Collaborative Health Systems will be managing four Direct Contracting Entities with a presence across 24 states. CHS currently manages two Next Generation ACOs, one Direct Contracting entity, eight MSSP ACOs, a Care Transformation Organization, and three Independent Practice Associations. CHS is a wholly owned subsidiary of Centene Corporation.

Meanwhile, athenahealth reports their ACO clients "earned a total of $143 million in savings in the 2020 Medicare Shared Savings Program (MSSP)", and among their ACO customers, "81% generated shared savings and 100% avoided losses. In addition, athenahealth’s ACO customers achieved an average quality score of 97.8% for 2020 and earned an average shared savings of $22.59 per member per month (PMPM), which compares to an average of $16.23 for all other ACOs participating in MSSP."

Milliman researchers recently published results of their analysis of ACO characteristics determined to be strongly predictive of MSSP gross savings, comparing current ACO performance analytics to a previous study conducted in 2015.

Milliman researchers found that the drivers of recent success are quite different and, in some cases, the opposite of what they were in 2015. With Pathways to Success, CMS endeavored to reshape the MSSP by adjusting incentives, encouraging greater accountability in ACOs, and offering options specific to each ACO’s ability to take on risk. Their analysis gives early indication that these changes are rewarding ACOs for attained efficiency levels, possibly enhancing the attractiveness of the program. Furthermore, the authors also see evidence of at least some correlation between tracks with downside risk and higher gross savings, supporting CMS’s case for accountability as a policy priority, though voluntary track selection may also be playing a role. Lastly, the authors see some indication that ACOs strongly emphasizing primary care are having greater success than their peers.

The Milliman team involved in this study will be presenting their findings in a new HealthcareWebSummit webinar: Key Drivers of ACO MSSP Results - What Predictive Analytics Can Tell Us, to be held Thursday, November 18^th, 2021 at 1PM Eastern.