Published on September 17, 2020

Essentia Health recognized by Medicare for excellent quality

Essentia Health has earned its best-ever quality score in the Medicare Shared Savings Program (MSSP). By meeting quality and cost goals in 2019, Essentia saved Medicare $13.2 million, according to the Centers for Medicare and Medicaid Services (CMS).

Essentia scored 95 percent for quality. To score that high, Essentia had to meet performance standards for 23 quality measures across four categories — patient/caregiver experience, care coordination/patient safety, preventive health and at-risk population.

The MSSP rewards health care providers for improving the quality of care and population health, as well as lowering health care costs. It focuses on successful and efficient patient outcomes rather than simply growing the volume of services delivered. The $13.2 million of gross savings to Medicare resulted in a shared savings payment of $9.5 million to Essentia, which will be reinvested in patient care, chronic care management and digital technology.

Compared to other CMS Accountable Care Organizations (ACOs), our work at Essentia resulted in a savings of between $304 and $683 per Medicare member in 2019.

“Moving from volume-driven, fee-for-service payment to value-based payment that rewards better patient outcomes and lower costs is a key strategic initiative at Essentia Health,” said Debbie Welle-Powell, chief population health officer at Essentia. “These results reinforce our commitment to high-quality affordable care for our patients and community. Working together, our patients, providers and CMS all benefit from improving quality, enhancing the patient experience while keeping costs down.”

Specifically, key factors in Essentia’s strong performance included:

  • Inpatient expenditures per beneficiary declined in 2019
  • Admissions also declined in 2019
  • Length of stay at Essentia’s skilled nursing facilities (21-22 days) continued to outperform the
  • ACO average of 24-25 days
  • At Essentia’s skilled nursing facilities, payment per stay declined, whereas the ACO average increased by about 2%

Essentia has been affiliated with CMS since 2012. In 2016, we entered into a contract that requires a specific amount of savings annually. If that level of savings is not achieved, we are responsible for paying back CMS. Since 2016, however, Essentia has outperformed cost-of-care benchmarks for ACOs.

“We put a stake in the ground around performance,” Welle-Powell said. “If you don’t perform, you pay back. We are making health care affordable while improving the quality of that care for our patients.”

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