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Mercyhealth saves Medicare nearly $45 million

Janesville Gazette - 10/3/2021

Oct. 3—Mercyhealth's Accountable Care Organization saved Medicare $15.6 million in 2020 and nearly $45 million since 2014, according to a news release.

Each year, Medicare evaluates the efficiency of every ACO and how well each performs based on established goals related to experience and quality of care. In return, these organizations receive a portion of those savings and may use those funds to reinvest in patient care.

When calculating shared savings, Medicare takes into account expenses it anticipates needing compared with historical costs. Regional spending and risk/illness regularity are also considered in the formula and are adjusted accordingly. If actual spending is less than the amount initially anticipated, the difference is classified as "savings" for Medicare.

Mercyhealth's ACO is composed of doctors, hospitals and clinicians who voluntarily coordinate to provide top-notch service in a patient-centered and family-friendly environment. According to the release, this group reaches around 18,000 beneficiaries who receive "safe, high-quality, accessible and affordable care."

In addition to the money saved, Mercyhealth's ACO achieved a quality score of 100% through its participation in the Medicare Shared Savings Program. The federal program focuses on improving health outcomes for beneficiaries, while also maintaining cost-effective practices.

The results of the 2020 report showed Mercyhealth's Medicare expenses averaged $8,967 per beneficiary, putting Mercyhealth in the bottom 15% of nationwide spending among Medicare ACOs.

Vice President Ladd Udy, of Value-based Care and Population at Mercyhealth, said that despite a lower forecast for expenses, the group managed to come out on top.

"They (Medicare) made a significant downward adjustment in their expected spending due to people not accessing care as much during 2020 due to the pandemic, and we still beat that goal," he said.

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