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Mercyhealth’s Accountable Care Organization (ACO) Helps Save Medicare Millions

Mercyhealth’s Accountable Care Organization (ACO) Helps Save Medicare Millions

What's new at Mercyhealth | Wednesday, September 29, 2021

Mercyhealth’s Accountable Care Organization (ACO) saved Medicare $15.6 million in 2020 while maintaining a quality score of 100% by the Centers for Medicare and Medicaid Services (CMS). This quality and cost performance was achieved through Mercyhealth’s participation in the Medicare Shared Savings Program, a federal program focused on improving Medicare beneficiaries’ health outcomes while maintaining cost-effectiveness.

ACOs are groups of doctors, hospitals and clinicians who come together voluntarily to give coordinated care to their Medicare patients. Although Mercyhealth formed an ACO under the CMS definition in 2014, it has been operating as a vertically-integrated organization for over 30 years, long pre-dating recent industry efforts to provide cost-effective care through coordination. Since 2014, Mercyhealth’s ACO has saved Medicare nearly $45 million.

Mercyhealth’s ACO includes about 18,000 Medicare beneficiaries and is one of over 500 ACOs in the United States, including over 30 with a presence in Illinois and Wisconsin. Physicians and clinician teams within Mercyhealth provide Medicare beneficiaries with safe, high-quality, accessible, and affordable care—all within a patient-centered and family-friendly experience.

Medicare evaluates how well each ACO meets goals related to quality and experience every year. ACOs receive a portion of any savings that result from reducing costs and meeting quality requirements, which can be used to re-invest in patient care capabilities.

Among the highlights for Mercyhealth’s ACO results in 2020:

  • Quality score of 100%
  • Total savings to Medicare of $15.6 million
  • Medicare expenses per beneficiary of $8,967, which is in the bottom 15% of Medicare ACOs nationwide for spending (lower spend is favorable, especially when combined with a high quality score)

“We are proud of the fact that we have consistently delivered value to our patients and communities, as evidenced by our track record of ACO results over the years,” said Javon Bea, Mercyhealth President/CEO. “Our 30 years of operating as a vertically-integrated health system with physicians and hospitals working as one entity has helped us develop a seamless integration of health care services and coordination among providers. We’ve had tremendous experience bringing high quality health care services at a cost-effective price for patients and payers for many years. This cumulative experience led to our excellent results in 2020 and positions us as a leader in making health care more affordable.”

About Mercyhealth: Mercyhealth is a multi-regional health system with more than 700 employed physician partners, seven hospitals and 85 primary and specialty care locations serving 55 northern Illinois and southern Wisconsin communities. Mercyhealth’s over 7,000 employee/partners care for over 2.4 million patient visits each year. As the top vertically integrated health care provider, they continuously work with a passion for making lives better for the people, families and communities they serve.