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

Mercyhealth’s Responsible Care Organization (ACO) saved Medicare $ 15.6 million in 2020 while maintaining a 100% quality score 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 the health outcomes of Medicare beneficiaries while maintaining profitability.

ACOs are groups of physicians, hospitals, and clinicians who come together on a voluntary basis to provide coordinated care to their Medicare patients. Although Mercyhealth formed an ACO as defined by CMS in 2014, it has operated as a vertically integrated organization for over 30 years, long before recent industry efforts to deliver cost-effective care through coordination. Since 2014, Mercyhealth’s ACO has saved Medicare nearly $ 45 million.

The Mercyhealth ACO includes approximately 18,000 Medicare beneficiaries and is one of more than 500 ACOs in the United States, including more than 30 with a presence in Illinois and Wisconsin. Mercyhealth physicians and clinician teams provide Medicare beneficiaries with safe, high-quality, accessible and affordable care, all in a patient-centered, family-friendly experience.

Medicare annually assesses how well each ACO is meeting quality and experience goals. ACOs receive a portion of the savings resulting from reduced costs and meeting quality requirements, which can be used to reinvest in patient care capabilities.

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

  • 100% quality rating
  • Total savings for Medicare of $ 15.6 million
  • Medicare spending per beneficiary of $ 8,967, which is among the lower 15% of Medicare ACOs nationwide for spending (lower spending is favorable, especially when it is combined with a high quality score)

“We pride ourselves on the fact that we have always provided value to our patients and our communities, as evidenced by our track record of ACO results over the years,” said Javon Bea, President / CEO of Mercyhealth . “Our 30 years of operating as a vertically integrated health system with physicians and hospitals working as one has helped us to develop seamless integration of health services and coordination between providers. For many years, we have had considerable experience in providing high quality healthcare services at a cost effective price for patients and payers. This cumulative experience has led to our excellent results in 2020 and positions us as a leader in making healthcare more affordable. “

About Mercyhealth: Mercyhealth is a multi-regional healthcare system with more than 700 employed partner physicians, seven hospitals, and 85 primary and specialty care centers serving 55 communities in northern Illinois and southern Wisconsin. Over 7,000 Mercyhealth employees / partners handle over 2.4 million patient visits each year. As the premier vertically integrated healthcare provider, they continuously work with a passion to improve the lives of the individuals, families and communities they serve.

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