Value-Based Care Leads The Way To Lower Costs And Better Quality

posted by James Swann, Senior Manager, Communications

on December 4, 2019

Americans deserve high-quality, affordable health care choices, and value-based care arrangements play a critical role in delivering on that commitment. Health insurance providers are focused on delivering value to patients, and Prominence Health Plan’s experience with a value-based shared-savings program underscores this.

Prominence operates seven Accountable Care Organizations (ACOs) that reward physicians who lower health care costs and improve quality for specific patient populations. The Prominence ACOs saved Medicare $65 million in 2018 and returned $30 million in savings to the 3,000 participating physicians. The savings are on top of an average 96% quality score since the first Prominence ACO started in 2014.

“The model rewards both the patient and physician as the patient receives better healthcare and the physician is financially incentivized for keeping them as healthy as possible,” Kamal Jemmoua, CEO of Prominence, said in announcing the 2018 results.

The Prominence ACOs are led by physicians but partner with hospitals to help reduce unnecessary procedures and lower overall costs. For example, partner hospitals notify physicians when an ACO beneficiary has been admitted or discharged. That level of coordination ensures that patients are receiving appropriate care.

The care coordination provides physicians with the right tools to provide high quality, high-value care, Jemmoua said.

The ACO concept is changing the way primary care medicine is being practiced in the United States, a change long overdue.

Prominence’s Nevada-based Silver Star ACO, for example, was the top ACO in the state and ranked in top 2% nationally. The Washington, D.C.-based GW Health Network was not only the top ACO in the city but also had a 100% quality score.

The Centers for Medicare & Medicaid Services launched the ACO model in 2013, and there are 518 ACOs operating across the country covering 11 million patients. ACOs saved Medicare $739 million in 2018, and have saved the program $2.7 billion since 2013.

A stronger American health care system is dependent on delivering high-quality care at a lower cost, and health insurance providers are focused on collaborating with doctors, nurses, hospitals, and pharmaceutical companies to make this happen. A more effective and affordable health care system benefits all Americans and provides them with financial stability and peace of mind.

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