MaineHealth ACO
Program Location:
Portland, ME
Payer Type:
Medicare
Partner Organizations:
MaineHealth ACO
MMC Physician-Hospital Organization
Parent Program:
Payers:
Medicare
Reported Outcomes
Description:
Through the Shared Savings Program, the MaineHealth Accountable Care Organization will work with CMS to provide Medicare fee-for-service beneficiaries with high quality service and care, while reducing the growth in Medicare expenditures through enhanced care coordination.
An effective Shared Savings Program includes:
- Patient-centered primary care medical homes that coordinate with other providers.
- Aligned networks of specialists, ancillary providers and hospitals focused on outcomes.
- Explicit care integration, transition of setting coordination and quality tracking and reporting.
- Payor provider partnership relationships and financial reimbursement models identified under healthcare reform that facilitate and reward high value, not high volume, healthcare.
- Population health information infrastructure to enable community-wide care coordination.
The MaineHealth ACO employs several primary intervention strategies including the patient-centered medical home model, care coordination, information technology, and variations and transparency.
Payment Model:
For an ACO’s first performance year, the repayment mechanism must be equal to at least 1 percent of its total per capita Medicare Parts A and B fee-for-service expenditures for its assigned beneficiaries, as determined based on expenditures used to establish the ACO’s benchmark (§425.204(f)). CMS estimates the amount of the ACO’s initial repayment mechanism based on available historical data, and will give this estimate to the ACO around the time CMS accepts its application.
To continue to participate in the program, each Track 2 ACO must annually demonstrate the adequacy of its repayment mechanism before the start of each performance year in which they take risk (§425.204(f)(3)). The repayment mechanism for each performance year must be equal to at least 1 percent of the ACO’s total per capita Medicare Parts A and B fee-for-service expenditures for its assigned beneficiaries, as determined based on expenditures for the ACO’s most recent performance year. Before the start of the next performance year, CMS will give Track 2 ACOs an estimate of the amount of the repayment obligation for which they must establish a repayment mechanism for the upcoming performance year.
How shared savings are distributed:
Reinvest in infrastructure:
20% of first million, 10% of second million is retained by the MaineHealth ACO. Up to 20% of balance may be retained by the MMC Physician-Hospital Organization
The balance is distributed to ACO Participants:
Hospitals: 40%
Primary Care Physicians: 27.5%
Specialists: 27.5%
Other network providers: 5%
Improved Health:
Improved diabetes management:
- HTN control at 75.1%
- HbA1c>9% at a rate of 16.4%
Improved Access:
- An average of 67.3% of patients said they received timely care, appointments, and information
Cost Savings:
- $19,196,823 in accrued savings for performance year 1, and $9,406,443 in earned shared savings payments from federal government
Increased Preventive Services:
- Exceeded depression screening goal of 82% with 85.2% screening rate
- Breast cancer screening rate at 79.4%
- Adolescent well visit goal of 50% exceeded at 59.8%
Last updated June 2019
