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Scottsdale Health Partners’ CMO Explains How His ACO Has Beaten MSSP Expectations

September 11, 2016
by Mark Hagland
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James Whitfill, M.D. shares his perspectives on how his organization has achieved MSSP ACO success

At a time when many accountable care organizations (ACOs) participating in the Medicare Shared Savings Program (MSSP) for ACOs are struggling to meet the cost-savings and quality-outcomes benchmarks set for them by senior officials at the Centers for Medicare & Medicaid Services (CMS), a minority of the MSSP ACOs are doing very well.

Among these is the organization that until a few weeks ago was known as Scottsdale Health Partners. A large multispecialty physician group based in Phoenix, Scottsdale Health Partners had 700 physicians at the time it joined the MSSP program in January 2014. Last month, Scottsdale Health Partners went through a merger with another local group, and has now taken the name Innovation Care Partners; the group now has over 1,200 physicians in the Phoenix area and in central Arizona.

The group’s new name does not reflect idle boasting: innovation has been a hallmark of the Scottsdale Health Partners group for years. Indeed, SHP was named by Healthcare Informatics’ editors as the second place-winning team in the publication’s Innovator Awards Program earlier this year, for its data-driven, multidisciplinary care team-led initiative to optimize care coordination and reduce avoidable readmissions. HCI Assistant Editor Heather Landi’s Innovator Awards profile of Scottsdale Health Partners can be read here.

Meanwhile, Scottsdale Health Partners was one of a small plurality of MSSP ACOs to be able to post outstanding cost savings and clinical outcomes results, when CMS officials announced results for the nationwide program, on August 25. As Managing Editor Rajiv Leventhal noted in his news report on that date, “Although more than 400 Medicare accountable care organizations (ACOs) generated more than $466 million in total program savings in 2015, nearly seven in 10 of those ACO organizations did not generate enough savings to receive bonuses, according to an Aug. 25 announcement from the Centers for Medicare & Medicaid Services (CMS).” Indeed, as Leventhal reported, “According to the just-released CMS data, 125 of the 404 total federal ACOs qualified for shared savings payments by meeting quality performance standards and their savings threshold. The results show that more ACOs are sharing savings in 2015 compared to 2014 and that ACOs with more experience in the Pioneer ACO Model and the Medicare Shared Savings Program (MSSP) tend to perform better over time. However, similar to last year, many of these ACOs did not produce enough savings to earn bonuses.”

But in a press release issued on Aug. 25, shortly after CMS’s national announcement of results, the leaders of Scottsdale Health Partners were able to state that “Scottsdale Health Partners, LLC is one of the ACOs that shared savings.” The SHP announcement quoted James Whitfill, the organization’s chief medical officer, as saying that “Scottsdale Health Partners has invested in physician engagement, innovative technology, and coordinated care models which has laid the foundation for this exciting news. As the first MSSP in Arizona to ever earn a performance payment from savings,” Dr. Whitfill said last month, “we are humbled that a second year of our positive results confirms our innovations are producing real and durable impact. We are particularly proud of our significant increase in quality scores to 94 [out of a possible 100] in this setting.”

James Whitfill, M.D.

Dr. Whitfill spoke last week with HCI Editor-in-Chief Mark Hagland regarding his organization’s accomplishments in the MSSP, and related subjects. Below are excerpts from that interview.

First of all, Dr. Whitfill, congratulations to you and your colleagues on your achievement.

Thank you.

So, let’s look at how you and your colleagues have achieved what you have, in the program. To begin with, when did you join the MSSP?

Scottsdale started out with a Medicare Advantage plan. We started in the MSSP in 2014—that was our first performance year. We were humbled to be the only MSSP based in Arizona that year earn shared savings that year, so for us to repeat that in 2015, and in 2015, we were one of three. In fairness, if you look at the files, there were two ACOs that span multiple states and have some presence in Arizona, that also achieved shared savings.

How much savings did you have to achieve to surpass your benchmark in 2014 and 2015?

In the end, we saved about $9.5 million on a population of 18,000 Medicare beneficiaries in 2015; in 2014, we saved around $3.8 million on a population closer to around 12,000 beneficiaries.

So you received a check each year?

Yes, the way Medicare does it—in this case, we got the results at the end of July for the 2015 performance year, and the information becomes public in August, and we anticipate the check by sometime in October, as that’s when we received it last year.

And what did you receive from CMS each year?

We got about a $1.8 million check in performance year 2014; for performance year 2015, we’ll receive a check for about $4.5 million. And not only did our financial savings go up considerably, our quality scores went up considerably as well, and we ended up with a score of 94 out of 100.