Harrisburg, Penn.-based River Health announced it will no longer pursue CMS’ Next Generation ACO program, just weeks after the new model launched. In a brief statement, River Health said that while it has been able to keep costs below the national average, “…projections do not indicate that the ACO would be able to meet the current target set by CMS."
River Health has been part of the Shared Savings Program since 2012 and serves about 33,000 beneficiaries not covered under a Medicare Advantage plan. In its last year of reporting (2014), it had shared losses of about $96 per enrollee.
River Health ACO is a partnership between Harrisburg-based PinnacleHealth System and Williamsport, Penn.-based Susquehanna Health.
Our Take: When we heard about the news at a conference early last week, something didn’t ring true about the reasoning behind it. So the next step was to dig a little deeper into the data.
In the chart below, we’ve selected two near-market MSSP ACOs for comparison—Keystone ACO, about an hour to the north in Danville, Penn. and Lancaster General Health, about 45 minutes east in Lancaster.
Here we have color-coded the 2014 reported results in a somewhat arbitrary, but nevertheless illuminating fashion. We calculated the average national score for each measure, then compared each ACO’s score to the average. If the ACO’s score was within 5% of the national average, we didn’t color-code it. If the ACO scored at least 5% better than the average, it earned a blue code. ACOs scoring 5.0–9.99 were coded yellow, and anything worse was coded red.
Looking at the data this way is a helpful way to make quick comparisons in a given region or market. What stands out at first glance is that all three can improve their BMI screening, as well as screening for high blood pressure and following up.
But the other obvious point to us—we’ve seen many markets represented in this colorized fashion—is that River Health is doing pretty well when it comes to aligning with CMS’ ACO quality measures. The average ACO looks more like Keystone, a smattering of color.
Financially, none of the three ACOs are doing particularly well, although these kinds of losses are typical for a first or second year of operations.
We’re speculating here, but our best guess is that River Health got their target number in late December, spent January negotiating with CMS, then finally threw in the towel.
Two questions remain: how many more Next Gen ACOs find themselves in a similar predicament? CMS only granted Next Generation contracts to 21 participants, so they don’t have much room for error if they want the program to succeed.
And is River Health ACO finished entirely? One would think so, given this sober ending to their 175-word press release:
“Each of our providers continues to seek to lead in providing high-quality, safe and low-cost care and coordinating care to promote better management of chronic illnesses, preventive care, and other methods to promote good health for all our patients.”