MSSP ACOs Generated Billions in Value-Based Care Savings in 2020

September 02, 2021 - It's back-to-school time, and the healthcare industry is likely to learn a lesson in value-based care from leading accountable care organizations.

MSSP ACOs Saved Medicare More Than $4B in 2020

The Medicare Shared Savings Program (MSSP) saved over $4 billion in 2020. Between the $1.9 billion in Medicare savings and $2.3 billion in accountable care organization (ACO) savings, this represents the program's best performance to date.

In 2019, ACOs showed large success in driving cost savings while improving care quality, and the trend persisted in 2020. ACOs managed to maintain savings in a year where healthcare systems were battling a pandemic.

RevCycleIntelligence breaks down the individual ACOs that earned the most shared savings payments in 2020 based on performance data CMS recently released for participants Medicare Shared Savings Programs. READ MORE

Highmark BCBS to Provide $12.3M in Rebates to Members, Employers

Highmark Blue Cross Blue Shield Delaware will distribute more than $12.3 million in Affordable Care Act rebates, the state’s insurance commissioner announced.

Eligible residents include enrollees who purchased health plans from the payer that were not on the Affordable Care Act marketplace, those who purchased plans on the Affordable Care Act marketplace, and small group health insurance marketplace policyholders.

Individuals on a policy eligible for a rebate will receive $8.4 million of the rebate return. Meanwhile, small businesses and other small group health insurance market policyholders will receive the remaining $3.9 million. Individual policyholders will receive on average $405, and small group health plans will see on average $1,514 in rebates out of a total of over $10,000. READ MORE

Biden Administration to Invest $10.7M in Pediatric Telehealth

The federal government is spending almost $11 million in stimulus funding on telehealth programs that expand access to pediatric mental health services.

Last week, the Health and Human Services Department announced that some $10.7 million will go into the Pediatric Mental Health Care Access Program, which enables pediatric mental healthcare providers to use connected health to consult with, train, provide assistance to, and participate in care management plans with primary care providers.

The money, administered through the Health Resources and Services Administration, expands the program’s reach. The HFMA had announced $14 million in funding this past May for 21 programs in 21 states; this additional funding boosts that number to 45 awards in 40 states, as well as Washington DC, the US Virgin Islands, the Republic of Palau, the Chickasaw Nation and the Red Lake Band of the Chippewa Indians. READ MORE

Machine Learning Aids Mortality Predictions in the ED

In a cohort study, researchers in Singapore and the United States compared how an interpretable machine learning triage tool for predicting mortality operates in a cohort of patients admitted to the hospital from the emergency department (ED) versus standard triage scores.

By using the machine learning tool, researchers were able to provide an accurate estimate of a patient’s risk of death. The study assessed all ED patients between January 1, 2009, and December 31, 2016.

Using statistical analysis, the study indicated that SERP had a better prediction rate than existing triage scores and maintained easy implementation and ease of ascertainment in the ED. According to the researchers, this method of mortality prediction could become broadly accepted in the healthcare community. READ MORE

Uber Health to Help Medicaid Members in Texas

A medical transportation partnership between Uber Health and the Texas Medicaid program is set to expand access to care to nearly 4.4 million people, helping to address transportation as a leading social determinant of health, the pair announced.

The partnership will allow Medicaid members in Texas to order rides to and from medical appointments via Uber Health and have that benefit covered as part of their Medicaid plan. This comes after 2019 legislation, spearheaded by Texas’ State House of Representatives Speaker Dade Phelan, added medical transportation as a Medicaid benefit.

Transportation is a critical social determinant of health. Individuals without cars, without the ability to drive, or another obstacle getting themselves to the medical office simply cannot attend their appointments. June 2020 data showed that almost six million people in the US missed a medical appointment in the previous year because they did not have medical transportation access. READ MORE

Phase 3 Trial Proves Successful for Merck’s Strep Vaccine

Merck recently announced that its pneumococcal 15-valent conjugate vaccine, Vaxneuvance, met key immunogenicity and safety endpoints in a Phase 3 clinical trial. In addition, secondary endpoints demonstrated superior immune responses for Vaxneuvance compared to PCV13 for shared serotype three and unique serotypes, as well as non-inferior immune responses to antigens contained in routinely used pediatric vaccines.

The PNEU-PED study enrolled infants 42 to 90 days of age. Researchers administered a four-dose regimen of either Vaxneuvance or the licensed 13-valent pneumococcal conjugate vaccine (PCV13) to infants at two, four, six, and 12-15 months of age.

Overall, Vaxneuvance had a safety profile comparable to PCV13. At 30 days following the third dose, Vaxneuvance was non-inferior to PCV13 for all shared serotypes and 12 of the 13 serotypes. At 30 days following the fourth dose, Vaxneuvance was non-inferior to PCV13 for all shared serotypes, based on serotype-specific immunoglobulin G (IgG) geometric mean concentrations (GMCs). READ MORE