Monarch Healthcare - CMS Pioneer ACO
Reported Outcomes
Description:
Monarch HealthCare is contracted with more than 2,300 independent, private-practice physicians who provide health care for approximately 176,000 Orange County residents. Recognized by health plans and business groups for providing high quality care and excellent service, Monarch HealthCare is operated by physicians who have demonstrated their commitment to advancing medical excellence and exemplifying the “patient-first” philosophy of healthcare in their communities. Under the Pioneer ACO Model, Monarch is required to meet quality standards based upon, among other measures, patient outcomes and care coordination. The Pioneer ACO Model includes strong patient protections to ensure that patients have access to and receive high quality care.
Payment Model:
The payment models being tested in the first two years of the Pioneer ACO Model are a shared savings payment policy with generally higher levels of shared savings and risk for Pioneer ACOs than levels currently proposed in the Medicare Shared Savings Program. In year three of the program, participating ACOs that have shown a specified level of savings over the first two years will be eligible to move a substantial portion of their payments to a population-based model. These models of payments will also be flexible to accommodate the specific organizational and market conditions in which Pioneer ACOs work.
Cost Savings:
- Monarch cut medical costs by 5.4% in 2012 from its baseline, which looks at the last three years of medical expenses, while national medical costs grew by 1.1% for a comparable population
- This favorable expense trend was driven primarily by reductions in hospital admissions and skilled nursing facilities utilization and unit costs
Other Outcomes:
Reported Outcomes:
https://www.uhc.com/content/dam/uhcdotcom/en/ValueBasedCare/PDFs/UHC-CaseStudy-MONARCH.pdf
Data Source(s):
Last updated August 2018
