Demonstrating what is possible when working together to deliver higher quality care at lower costs, New Hanover Regional Medical Center’s Medicare Shared Savings Program Accountable Care Organization (ACO), Physician Quality Partners (PQP), earned top scores in the latest data released by the Centers for Medicare & Medicaid Services (CMS).
PQP improved care for almost 20,000 Medicare beneficiaries in New Hanover and the surrounding counties, saving Medicare over $9.7 million by meeting quality and cost goals in 2019, according to recently released performance data from CMS, the federal agency that administers Medicare. PQP reduced the average cost of care by $501 per beneficiary.
PQP earned a quality score of 98.75 percent on performance measures ranging from preventive health checks, to use of electronic health records, to preventing avoidable hospitalizations, according to Medicare data.
“Our work to improve care and quality while lowering costs within this group is just the beginning of what we can do to improve our region’s health,” said NHRMC President and CEO John Gizdic. “By growing in our ability to provide new care options and access data that can be used to identify ways to improve care, we can help more people and lower overall costs.”
The $9.7 million of gross savings to Medicare that PQP generated also resulted in a shared savings payment of $4.4 million to PQP, which will be used to help fund further investments in quality improvement and care management support to improve our beneficiaries’ health outcomes.
“Partnering with our ACO providers is foundational in better serving patients, driving outcomes, and delivering value in this complex healthcare landscape,” said Leelee Thames, MD, MBA, NHRMC’s Chief Value Officer and ACO Medical Director. “ACOs like ours are not only driving down costs, but most importantly, making remarkable improvements in the health and quality of life of our beneficiaries.”
For example, PQP providers strive to improve long-term outcomes by directing efforts to services like annual wellness visits and evidence-based preventative screenings, known to impact disease conditions. The ACO also focuses on ensuring care is coordinated to ensure smooth transitions from the hospital to home — or a nursing home if needed. All ACO providers receive detailed information about their performance on quality measures, and clinicians and providers share best practices to coordinate the care beneficiaries receive to prevent complications and repeat hospitalizations.
Through these efforts to improve outcomes, PQP’s hospital admission rates dropped 17% and ED rates dropped 6.3% since the program’s inception in 2016. Over the last year alone, PQP reduced unnecessary admissions and readmissions by over 2%, and Emergency Department visit rates by over 3%.
ACOs empower local physicians, hospitals and other providers to work together and take responsibility for improving quality, enhancing patient experience and keeping care affordable. The Medicare Shared Savings Program (Shared Savings Program) creates incentives for ACOs to invest in transforming care by allowing them to share in savings they generate after meeting defined quality and cost goals.
According to CMS, 541 Shared Savings Program participants generated $1.19 billion in total net savings to Medicare in 2019. ACOs continued to show improved or comparable quality performance on measures compared to other physician group practices.
“The Medicare ACO shared savings program is the largest value-based payment model in the country and a critical tool in moving the health system toward higher value,” said Lydia Newman, PQP’s Executive Director.
PQP is a collaborative that includes the NHRMC Physician Group and Intracoastal Internal Medicine, an independent practice in Wilmington.
About Physician Quality Partners
Founded in 2013, Physician Quality Partners (PQP) was created by New Hanover Regional Medical Center. The participating providers are united with the common goal of helping beneficiaries receive the right care, at the right time, in the right setting. In 2016, PQP began participating as a Tack 1 ACO in the Shared Savings Program and renewed participation on July 1, 2019 in the new Pathways to Success Model as a Track B participant. To learn more about Physician Quality Partners, call 910-667-7640 or visit www.physicianqualitypartners.com. You also can call 1-800-MEDICARE (1-800-633-4227), TTY users should call 1-877-486-2048 and tell the representative you’re calling to learn more about ACOs or visit Medicare.gov/acos.html.