AUSTIN, Texas--(BUSINESS WIRE)--Three Texas Accountable Care Organizations (ACOs) formed through TMA PracticeEdge were among state and national leaders in delivering quality care, improving patient outcomes, and generating more than $17.5 million in Medicare savings during the 2018 Medicare Shared Savings Program (MSSP) performance year.
The Centers for Medicare and Medicaid Services (CMS) rewards MSSP participants with a share of their cost savings based on quality performance. While all 53 Texas ACOs achieved CMS’ quality requirements in the 2018 performance year, only 28 lowered cost of care. The three started by TMA PracticeEdge stand out.
“When the Texas Medical Association created our organization in 2015, we knew that with the right tool set, ACOs owned and led by physicians could deliver the quality improvement and cost efficiency needed to succeed in emerging value-based care models,” said David Spalding, chief operating officer of TMA PracticeEdge. “TMA PracticeEdge ACOs have not only delivered on their promises, but they – along with many other physician-owned organizations – are setting standards for the market.” According to TMA PracticeEdge’s analysis, only 10 of the 28 savings-generating ACOs were sponsored by hospitals.
Representing 154 primary care physicians, the three TMA PracticeEdge ACOs—UPSA ACO of San Antonio, Genesis Physicians Group of Dallas, and Alliance ACO of rural central Texas—earned more than $7 million in shared savings incentives as the affiliated physicians cared for more than 26,500 Medicare beneficiaries.
According to the CMS 2018 MSSP reporting data:
Alliance ACO lowered the cost of care by 10.9% — the highest savings rate in Texas and the eleventh best in the country. $9.3 million in savings was achieved via a 28% reduction in hospital and other in-patient services since 2016, along with diligent management of patients with chronic conditions which lowered costly emergency department visits by 22%.
“Thirteen primary care practices across Central and South Texas saved more than $1,900 per Medicare beneficiary. We are so proud of our physicians who have shown that building a close relationship with patients to manage their care results in a healthier population. Alliance is a great example of how there is plenty of room in rural Texas for independent physicians to make a difference in their communities.” – Garth Vaz, MD, Co-President, Alliance ACO.
UPSA ACO, with 52 physicians and growing, was the second smallest organization in Texas to achieve shared savings. The group earned an overall quality score of 94%, one of the highest in Texas, while saving $4.6 million.
UPSA leads Texas with the highest rate for colorectal cancer screenings at 85.4% The group also made significant strides in managing diabetic patients with a more than fifteen-point improvement in quality scores for Hemoglobin A1c control, diabetic eye exams, and unplanned hospital admissions due to diabetic complications.
"Independent physicians, the traditional advocates for patients’ rights, are the best hope for reducing cost while improving quality as we go through this period of health care transformation. Our success in partnership with Medicare is evidence that this is true. In this model everyone wins. All like-minded primary care doctors should consider taking a close look at independent ACO opportunities in their area.” – Lloyd Van Winkle, MD, President of UPSA ACO.
Genesis Physicians Group accomplished $3.4 million in savings in its first year of participation in the MSSP program, despite the fact that ACOs with the most years of involvement and participation with MSSP typically are the highest-performing ACOs (according to analysis of CMS data) .
This ACO also ranked in the top three performers in Texas for patient satisfaction scores related to timely appointments, shared patient-physician decision making, patient communications, and good stewardship of patients’ health resources.
“In our first year with the MSSP Track 1+ contract, Genesis physicians enthusiastically embraced population health strategies to address avoidable health care expenses and utilization for our 7,900 Medicare-insured patients. As a result, we reduced costs by $438 per Medicare beneficiary while increasing preventive care services and patient satisfaction. These results support the conventional wisdom that independent physician organizations have an important role to play in the future of health care delivery for Texans.” – Jim Walton, DO, President and CEO of Genesis Physicians Group.
ABOUT TMA PRACTICEEDGE: TMA PracticeEdge is a trusted ally in creating physician-led accountable care organizations (ACOs) as physicians fight to maintain independence, clinical autonomy, and the primacy of the patient-physician relationship.
Along with Innovista Health Solutions, TMA PracticeEdge manages 15 physician-owned and led ACOs across Texas, offering technology, data analytics, and clinical and management teams that work with physicians to impact quality of care, lower health care costs, and improve patients’ experience. To date, more than 540 independent primary care physicians have joined TMA PracticeEdge in 45 counties across Texas. 85% of ACO members are in solo or small practice, serving 250,000+ patients in value-based care contracts consisting of Medicare Shared Savings, Medicare Advantage, and commercial contracts.