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Happy Tuesday, Hospitalogists!

No exclusive this time around (unless you're trying to go exclusive with me, aha) but I DO have a great newsletter with some analysis on the Medicare Shared Savings Program. Performance Year 2024 dropped in the last couple of weeks and I've always been curious about how I might slice the data, so I took a shot at it.

If there's something particular you want to see or are interested in when it comes to ACO performance, let me know!

Let's get to it.

Trend Analysis: MSSP 2024 Results

Diving into MSSP savings

Resources:

• CMS data for MSSP performance year 2024 (what we’re studying today)
• CMS summary of MSSP 2024 results
• MedPAC Alternative Payment Models Overview

Company specific MSSP announcements

• Privia Health MSSP announcement: Privia Health ACOs Delivered $233+ Million in Total Savings in the 2024 Performance Year of Medicare Shared Savings Program, a 32% Year-over-Year Increase
• Aledade: Aledade ACOs save over $1B in 2024
• I haven’t seen any announcements yet for Wellvana, Evolent, Astrana, etc.

Summary of overall MSSP results

• $6.5B savings generated in 2024 ($4.1B of which retained by participating ACOs) up from $5.2B saved in 2023
• CMS is finding improvement in quality measures like blood pressure, depression, and diabetes
• 476 ACOs covered 10.3M lives
• On that point...the number of ACOs and lives covered has held basically flat over the past 5 years. What gives? If Medicare is growing and MSSP is the most successful accountable care program by savings generated, where’s the market growth? This program as a whole has stayed flat, while savings generated seem to be increasing. The other lives are…captured within Medicare Advantage I would presume.

...And I think I answered my own question after finding this graphic from MedPAC (linked above):

Top 10 ACOs by gross savings

Top 10 ACOs by Savings Rate

Largest 20 ACOs by Membership and Associated Performance

Bottom 10 ACOs by Gross Losses (16 ACOs owed $20.3M collectively in shared losses)

Bottom 10 ACOs by Savings Rate

Performance by Revenue Size and Track (low revenue ACOs continue to outperform high revenue ACOs) 

Assuming I labeled all the ACOs correctly (which is a big assumption, so take it with a grain of salt) here are some of the notable enablers and their performances.

Note that I pulled in acquired entities. So Wellvana will have all of CVS’ MSSP portfolio, and Astrana with CHS, etc. It may not be perfect, but it is probably pretty close or directionally accurate. Also, notable that Aledade’s total membership is 11.2% of all of MSSP, quietly, through nearly 60 ACOs in the program, and savings generated comprising nearly 17% of all gross savings within MSSP. 

How else would you want to see the data sliced? There are so many ways to do it. Let me know your thoughts!

TOP READS & RESOURCES

My favorite reads & resources from the week

• In case you missed it - I had the chance to exclusively interview Baylor’s leadership on their latest JV in behavioral health, a first of its kind partnership with Geode Health! Read it here.

• Hospital leaders: RSVP for LiveData’s “What Your EHR Doesn’t Know About Surgery” webinar on September 25. Get tips to enhance patient flow communication, improve margins, and make performance data easier to share.*

• This MedPAC report analyzing the association between changes in MA enrollment / penetration and hospital finances was interesting and full of notable insights. Anecdotally most health system leaders will tell you MA is net negative to Medicare on a reimbursement basis due to denials and administrative overhead. MA penetration sits at 55% nationwide.

*This read is brought to you by one of my brand partners who help make this newsletter possible!

MISCELLANEOUS MADDENINGS

Random personal anecdotes and musings from me

I gotta say, I'm not the most enthused with Texas' performance through 2 games. I'll withhold judgment until a little more ball is played but we're looking more like a top 20 team through 2 games than a top 5 or 10. Just my $0.02.

Alcaraz was absolutely balling and I loved seeing him destroy Sinner on the hard court.

Please pray for my sod installation. I am watering 3x/day in 90 degree heat and my son's 2-year old birthday party is at the end of the month. I am WATCHING. GRASS. GROW.

Hospitalogy is closing in on 50,000 subscribers which is insane to say. Onward and upward, fam. I appreciate each and every one of you, even when I forget to check the Hospitalogy email for multiple weeks...whoops.

Thanks for the read! Let me know what you thought by replying back to this email.

— Blake