EBrightHealth ACO reduced overall health care spending by $11.3 million, as compared to the CMS benchmark, for its 50,000 Medicare beneficiaries in Delaware, Pennsylvania and Maryland, while achieving an overall Quality Score of 88%., according to data released in the U.S. Centers for Medicare & Medicaid Services' 2018 Performance Results and Quality Report.
"This incredible achievement is a testament to the hard work and dedication of the physicians and health systems of eBrightHealth ACO," said Christine Donohue-Henry, M.D., MBA, president and CEO of eBrightHealth ACO. "We have achieved this by focusing on the health of our beneficiaries and staying true to foundational elements of care, including transitions of care, care coordination, data-sharing, quality improvement and the transformation of our practices to ensure that our beneficiaries are receiving the right care, at the right place, at the right time."
"All of this work supports engaged relationships between patients and their primary care teams that address manageable problems before they turn into serious medical complications," she said. "We're seeing the results, as unnecessary hospital utilization is decreasing for our beneficiaries across the ACO."
EBrightHealth ACO, which comprised 1,400 partnering primary and specialty care clinicians and five health systems in 2018, has achieved three consecutive years of savings that total $13 million while maintaining a high level of quality in the care that it provides. That care is supported by Christiana Care's award-winning care coordination program Carelink CareNow, which harnesses real-time data and predictive analytics to identify opportunities to help patients better manage their health — and avoid complications that might lead to unnecessary hospitalizations or avoidable visits to the emergency department.
During the period represented in the 2018 Performance Results and Quality Report, eBrightHealth ACO comprised five regional health systems — Atlantic General Hospital, Bayhealth, Beebe Healthcare, Christiana Care and Nanticoke Health Services — nine private primary care practices and two federally qualified health centers, Westside Family Healthcare and La Red Health Center.
Collectively, they achieved an overall Quality Score of 88%. The Quality Score measures domains such as patient and caregiver experience, care coordination and patient safety, preventive health and at-risk populations.
Since its founding in 2016, eBrightHealth ACO has participated in a payment model in which the partners can share savings with the government if quality and cost criteria are met. Buoyed by its success, eBrightHealth ACO will enter a two-sided risk model for the first time in its history, beginning Jan. 1, 2020, in which the partners will be eligible for shared savings — or liable for increased spending, if it occurs.
"We are excited to take this next step, in which the eBrightHealth ACO partners will take on both upside- and downside risk," Dr. Donohue-Henry said. "We believe that value-based care is the key to continued improvement in the quality of care and continued reductions in cost. Through the diligence of our outstanding partnering clinicians and health systems, eBrightHealth ACO will rise to this challenge and continue to transform the care we deliver to our Medicare beneficiaries — and our community."