Risk Sharing Specialists

Until two years we tracked ACO performance quarterly. Of those 238 ACOs at that time, only 18% made a distribution and the average distribution was only equivalent to $150 per month. Recently that number has plummeted to less than 6%. Out of the many hundreds of ACOs, only 30 achieved any shared savings in 2021. Next year with new ACO REACH requirements, we will be lucky to see 1-2% achieve shared savings. Such horrible performances yet the boast that they had near perfect MIPS (for example) scores. Why?

In an effort to “save money for distribution”, most of these organizations have avoided performing services that are now required such as Annual Wellness Visits (AWVs), Chronic Care Management (CCM), Remote Patient Monitoring (RPM), Behavioral Health Integration (BHI) and Transitional Care Management (TCM), which targets reduction of hospital readmissions. Very few have any idea how they will be able to provide these services, especially with little or no reimbursement. We have solutions!

MIPS (for example) scores are the “Test”, but the CMS Standard of Care (CMS SOC) is the “Class”. These groups pass the test but fail the class due to lack of understanding of CMS SOC compliance. The truth is NOT providing these services is exactly WHY they have no shared risk distributions. The fact is that without providing these services you can’t generate the metrics necessary to achieve these gains. 

Our team is led by a former Market President of a Big Three insurance company, whose sole responsibility was turning around their failing ACOs and Medicare Advantage plans. She found that the system she spent 15 years manually creating, could be automated via our technology. The cards are now stacked in our favor … and YOURS!