CHPA Earns High Quality Marks, Saves Medicare Money – PY21

Full press release linked here: CHPA Press Release 10/3/2022

Denver, Colorado — Community Health Provider Alliance (CHPA) improved care for 13,998 Medicare beneficiaries in the state of Colorado and saved Medicare $14,606,523 by meeting quality and cost goals in 2021, according to recently released performance data from the Centers for Medicare & Medicaid Services (CMS), the federal agency that administers Medicare. That’s a saving to the system of $1,043 per Medicare beneficiary, while at the same time maintaining high-quality patient care.

Medicare data shows CHPA earned a quality score of 84.81 percent on performance measures ranging from preventive health checks to the use of computerized health records to preventing avoidable hospitalizations. The $14,606,523 of gross savings to Medicare resulted in a shared savings payment of $5,725,756.88 of shared savings payments to CHPA, 60% of which will be distributed to the participating member Federally Qualified Health Centers (FQHCs), also known as Community Health Centers (CHCs).

CHPA joined the CMS Medicare Shared Savings Program (MSSP) in 2017 and shared savings were first earned in the third performance year of 2019. CHPA has continued achieving savings since then, obtaining $37.6 million in total savings for CMS over the last three years. Even throughout the global COVID-19 pandemic, quality scores remained above 84%, and CHPA continues to implement various programs to reduce the total cost of care while improving quality and patient satisfaction.

Member CHCs who participated in the MSSP program work to increase the number of Medicare beneficiaries taking advantage of annual wellness visits, including recommended screenings and preventive care. The ACO also focuses on ensuring smooth patient transitions from the hospital to home and provides various supports to manage patients with chronic conditions and complex social risk factors. All member CHCs receive detailed information about their performance on quality measures from CHPA. And clinicians and providers share best practices to coordinate the care beneficiaries receive from different primary care and specialty providers to prevent health issues and repeat hospitalizations.

CHPA’s member CHCs have independent electronic health records (EHRs) and in addition to achieving savings in the 2021 performance year, CHPA was one of only 12 accountable care organizations (ACOs)—out of a total of 475 participating—able to report electronic clinical quality measures (eCQMs). This was due to collaborative relationships with several key partners who also serve the CHCs.

CHPA member CHCs who participated in the MSSP program include:

  • Axis Health Systems
  • Clinica Family Health Services
  • High Plains Community Health Centers
  • Marillac Health
  • Northwest Colorado Health
  • Peak Vista Community Health Centers
  • Pueblo Community Health Center
  • Salud Family Health Centers
  • Sheridan Health Services
  • STRIDE Community Health Centers
  • Summit Community Care Clinic
  • Sunrise Community Health
  • Tepeyac Family Health
  • Valley-Wide Health Systems

A market-based solution to fragmented and costly care, ACOs empower local physicians, hospitals, and other providers to work together and take responsibility for improving quality, enhancing patient experience, and keeping care affordable. The MSSP creates incentives for ACOs to invest in transformed care by allowing them to share in savings they generate after meeting defined quality and cost goals.

In 2021 nationally, 475 ACOs caring for over 10 million beneficiaries participated in the MSSP, generating gross savings of $1.96 billion based on the CMS methodology for setting financial benchmarks. After accounting for shared savings earned by ACOs in 2021, estimated net Medicare savings were $900 million.

“The Medicare Shared Savings Program demonstrates how a coordinated care approach can improve quality and outcomes for people with Medicare while also reducing costs for the entire health system,” said CMS Administrator Chiquita Brooks-LaSure. “Accountable Care Organizations are a true Affordable Care Act success story, and it is inspiring to see the results year after year.”

A fact sheet with more information about MSSP ACOs is available online, along with other resourcesWhat is an ACO?and the ABCs of ACOs.