Prominence Health Plan Reveals Increased Cost Savings, Improved Quality of Care in Its 2018 Results

December 2, 2019
Matthew Gavidia
Matthew Gavidia

Matthew is an associate editor of The American Journal of Managed Care® (AJMC®). He has been working on AJMC® since 2019 after receiving his Bachelor's degree at Rutgers University–New Brunswick in journalism and economics.

Prominence Health Plan announced that its 7 Universal Health Services (UHS) Accountable Care Organizations (ACOs) revealed a continued trend of increased cost savings and improved quality in 2018 results.

Prominence Health Plan announced that its 7 Universal Health Services (UHS) Accountable Care Organizations (ACOs) revealed a continued trend of increased cost savings and improved quality in 2018 results.

A subsidiary of UHS, Prominence Health Plan’s 7 ACOs operate through a group of physicians who agree to reduce costs and increase quality within a value-based contract. These shared-savings agreements incentivize physicians to alter the healthcare cost curve, manage utilization, and promote high-quality care through a transition from volume-based payments to value-based payments. Participating providers are also incentivized as they can earn back part of the savings that they generate for Medicare by meeting preset spending goals.

In its published results, Prominence Health Plan detailed the effectiveness of its ACOs in saving Medicare $65.2 million and further earning $30 million for its 3000 participating physicians. Kamal Jemmoua, MS, CEO of Prominence Health Plan, described the ACO concept as a change that has been long overdue within applied practices of primary care medicine. “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,” said Jemmoua.

Notable highlights from the report include several UHS ACOs that were included in state rankings based on attributed cost savings:

  • Silver State ACO in Nevada: ranked first in the state for program savings with $33.9 million, ranked in the top 2% nationally
  • Texas Panhandle Clinical Partners: ranked 6 out of 53 ACOs in the state of Texas for savings rate and brought in $13 million in program savings to rank in the top 7% nationally
  • South Texas Clinical Partners: ranked 10 in the state in program savings at $11.4 million, the highest total savings compared to market competition with a 100% quality score
  • GW Health Network: ranked first of 9 ACOs in the Washington, DC, area in savings rate with a total program savings of $3.3 million and with a 100% quality score

“This success is the outcome of intentional partnership within UHS communities, empowering local primary care clinicians with the necessary data and resources to provide high quality, high-value care,” said Jemmoua.

The ACO program was established by CMS to improve the quality of care and lower costs for Medicare beneficiaries. Since being implemented in 2013, ACOs have saved Medicare $2.66 billion.

UHS ACOs employ their own distinct practice through focusing on primary care with community partnership in post-acute and specialty care. As ACOs are normally physician-led, the hospital-sponsored aspect to UHS’ version differentiates it from other ACOs. The hospitals provide capital funding, partnership in downside risk, and integrated ACO-friendly hospital initiatives focused on avoiding unnecessary utilization and increasing communication with ACO providers. Administrative oversight and data analytics are additionally provided by UHS for ACO operations.

Robert Sanders, MD, internal medicine physician for TexomaCare, noted that the UHS ACO program affiliated with his practice has generated an improvement of care for all patients. “The ACO has encouraged our providers to focus on specific high-value activities for our patients, as well as consider non-traditional social and environmental factors when addressing their overall care,” said Sanders.