Care Solutions ACO | CenterWell Senior Primary Care

Tamaño de texto:

What is an ACO (Accountable Care Organization)?

An ACO, or Accountable Care Organization, is a group of healthcare providers, such as doctors, hospitals, and other healthcare professionals, who come together to deliver high-quality care to Medicare patients. Under the Centers for Medicare & Medicaid Services (CMS), ACOs are designed to improve the coordination and efficiency of care while ensuring patients receive the best outcomes. By working together, ACOs can help lower healthcare costs and improve the overall patient experience, making healthcare more accessible and effective.

Our Continued Partnership with Medicare: ACO REACH

Starting in 2023, CenterWell Care Solutions continued its partnership with Medicare as part of the ACO REACH model. This model is designed to focus on delivering equitable, accessible, and high-quality care to Medicare beneficiaries. Through ACO REACH, CenterWell Care Solutions works to improve care coordination, reduce healthcare costs, and ultimately deliver better patient outcomes. We believe that by partnering with Medicare and healthcare providers, we can make a meaningful difference in the lives of our patients, ensuring they receive the right care at the right time.

A Track Record of Performance

CenterWell Care Solutions has made significant strides in improving quality and reducing costs, with the following 2023 key achievements.

These achievements directly impact patient care and the ACO by:

• Lowering Hospital Admissions

• Avoiding Unplanned Admissions for Chronic Disease Patients

• Timely Follow-Up Care Post-Discharge

Through these efforts, CenterWell Care Solutions continues to excel in both cost reduction and quality improvement, benefiting both Medicare and the patients we serve.

15.7%

Savings Rate

$9.4 million

Total Cost of Care Savings

98.4%

Quality Score

CenterWell Care Solutions is committed to improving healthcare outcomes and enhancing the patient experience.

The ACO REACH (Realizing Equity, Access, and Community Health) model, CenterWell is working with CMS to provide more coordinated, patient-centered care. This model focuses on improving care quality, addressing health disparities, and reducing healthcare costs. By participating in the ACO REACH model, CenterWell Care Solutions continues to prioritize delivering high-value care that benefits both patients and healthcare providers In 2021, CenterWell Care Solutions began contracting with CMS to participate in initiatives aimed at improving care quality and lowering healthcare costs. Our goal has always been to foster a collaborative approach between patients and providers to better coordinate care and treatment options. We understand that effective communication and collaboration are key to improving health outcomes, and we are dedicated to helping patients navigate their healthcare needs.

CenterWell Care Solutions Inc. is a separate entity under Humana’s Primary Care Organization that is contracted directly with CMS and bears responsibility of financial risk under the ACO REACH program. CenterWell Care Solutions reinvests shared savings into Humana’s Primary Care Organization to help drive patient engagement and improve care for Medicare beneficiaries. Moreover, CenterWell Care Solutions Inc. is wholly owned and does not maintain any joint venture partnerships.

It’s important to note that Medicare patients’ benefits remain unchanged. Beneficiaries can still see any doctor, hospital, or healthcare provider that accepts Medicare. However, by being aligned with an ACO, Medicare patients become eligible for additional benefits, including more proactive and enhanced care coordination services. This means that patients will receive better support in managing their health, ensuring they get the right care when they need it most.

Participating in an ACO also allows for better data sharing and insights into a patient’s medical history, which can help inform their care plan. This collaboration between healthcare providers aims to enhance personalized and timely patient care by leveraging a comprehensive understanding of their health, leading to better outcomes and a more streamlined healthcare experience.

Performance Year 2023 (Centers for Medicare and Medicaid Services. “PY2023 ACO REACH Financial Results.” CMS.gov, 8 Nov. 2024, aco-reach-py2022-fin-qual-results.xlsx):

Total Quality Score: 98.4%
Risk-Standardized All-Condition Readmissions (ACR) Score: 15.31 (a lower score indicates better performance)
Risk-Standardized, All-Cause Unplanned Admissions for Patients with Multiple Chronic Conditions (per 100 person-years) (UAMCC) score: 27.60 (a lower score indicates better performance)
Total Shared Savings: $9.4MM
Proportion of Shared Savings invested in infrastructure, redesigned care processes and other resources: 25% of the savings were reinvested to strengthen population health capabilities, including data and analytics tools.
Proportion of Shared Savings distributed to providers: the ACO primarily operates on a physician staff model, where 100% of the savings is allocated to the parent company.

Performance Year 2022 (Centers for Medicare and Medicaid Services. “PY2022 GPDC Financial Results.” CMS.gov, 23 Oct. 2023, gpdc-py2022-financial-results.xlsx):

Total Quality Score: 100%
Risk-Standardized All-Condition Readmissions (ACR) Score: 15.33 (a lower score indicates better performance)
Risk-Standardized, All-Cause Unplanned Admissions for Patients with Multiple Chronic Conditions (per 100 person-years) (UAMCC) score: 34.33 (a lower score indicates better performance)
Total Shared Savings: $7.3MM
·Proportion of Shared Savings invested in infrastructure, redesigned care processes and other resources: 25% of the savings were reinvested to strengthen population health capabilities, including data and analytics tools.
Proportion of Shared Savings distributed to providers: the ACO primarily operates on a physician staff model, where 100% of the savings is allocated to the parent company.

Performance Year 2021 (Centers for Medicare and Medicaid Services. “PY2021 GPDC Financial Results.” CMS.gov, 23 Nov. 2022, Appendix_GPDC PY2021 Financial Results.xlsx):

Total Quality Score: 100%
Risk-Standardized All-Condition Readmissions (ACR) Score: 15.74 (a lower score indicates better performance)
Risk-Standardized, All-Cause Unplanned Admissions for Patients with Multiple Chronic Conditions (per 100 person-years) (UAMCC) score: 32.69 (a lower score indicates better performance)
Total Shared Savings: $3.8MM
Proportion of Shared Savings invested in infrastructure, redesigned care processes and other resources: 25% of the savings were reinvested to strengthen population health capabilities, including data and analytics tools.
Proportion of Shared Savings distributed to providers: the ACO primarily operates on a physician staff model, where 100% of the savings is allocated to the parent company.

At CenterWell Care Solutions, we are committed to transforming healthcare by improving patient outcomes, enhancing care coordination, and optimizing value-based care for providers. As a participating provider, you gain access to resources, support, and incentives designed to help you succeed in a value-based environment.

Why Join Our ACO?

Enhanced Care Coordination – Improve patient outcomes with streamlined, data-driven care models.

Performance-Based Incentives – Participate in shared savings opportunities and innovative reimbursement models.

Operational & Clinical Support – Leverage population health analytics, provider engagement tools, and dedicated support teams.
Flexibility & Alignment – Work collaboratively within a network that prioritizes patient-centered care while maintaining provider independence.

We also provide further opportunities for providers through our MSO, CenterWell IPA Solutions. CenterWell IPA Solutions offers providers the resources to build better, more efficient practices without sacrificing their independence. Our value-based care model focuses on patient care while building scalable, successful practices. As a payor agnostic organization, we work across many health plans and lines of business, creating better health for seniors and practices.

To learn more about CenterWell IPA Solutions, visit our website linked here.

General Info: The ACO benefits enhance the care experience for aligned Medicare patients by providing more personalized, coordinated healthcare services. This model allows healthcare providers to work together seamlessly, ensuring that patients receive the right care at the right time, leading to better health outcomes. By aligning with Medicare, patients gain access to additional benefits such as proactive care management, improved care coordination, and a focus on preventive services. The ACO model emphasizes a holistic approach to patient care, reducing unnecessary hospitalizations and improving the overall patient experience through integrated services.
Care Management Incentive Benefit: The Care Management Gift Card Incentive Benefit supports aligned Medicare beneficiaries by encouraging active engagement in their healthcare. Patients who partner with their care navigator to receive care management and care coordination services are eligible to receive an incentive in the form of a gift card. This incentive helps motivate patients to take an active role in managing their health, promoting better communication with their care team, and staying on track with their healthcare plan. By engaging in these services, beneficiaries are empowered to make informed decisions, leading to improved health outcomes and a more proactive approach to their care.
Part B Cost Share Benefit: The ACO Part B Cost Share Benefit is designed to help remove financial barriers for its members by paying for patient coinsurance responsibility for eligible Part B services. This benefit ensures that patients receive the care they need without financial obstacles, making it easier for them to visit their primary care providers. By reducing coinsurance costs, the ACO Cost Share Benefit encourages patients to stay engaged with their health, ensuring they receive timely preventive services and ongoing care.

Learn more about the benefits and personalized care we offer:

ACO Benefits Guide

CenterWell Care Solutions - Clinical and Administrative Leaders:

Renee Buckingham – President, Humana Primary Care Organization
Dr. Vivek Garg – Chief Medical Officer, Humana Primary Care Organization
Richard Lindsay-Jones – Vice President, Chief Financial Officer, Humana Primary Care Organization
Dr. Erika Pabo – Chief MSO Operations Officer, Humana Primary Care Organization
Terri Schorr – Associate VP, Medicare Compliance, Humana

Renee Buckingham – President, Humana Primary Care Organization
Dr. Vivek Garg – Chief Medical Officer, Humana Primary Care Organization
Dr. Lee Epstein – Market Chief Medical Officer, ACO Participant Provider, Conviva Care Centers
Dr. Anitha Mullangi – Market Chief Medical Officer, ACO Participant Provider, Conviva Care Centers
Dr. Sonali Kumar – ACO Participant Provider, CenterWell Senior Primary Care
Dr. Jessica Rosario – ACO Participant Provider, CenterWell Senior Primary Care
Dr. Soett Ramirez-Estrada – ACO Participant Provider, CenterWell Senior Primary Care
Dr. Jacquelin Castillo – ACO Participant Provider, Conviva Care Centers
Dr. Prasanth Rao – ACO Participant Provider, Conviva Care Centers
Caitlin Donovan – Senior Director, National Patient Advocate Foundation
Gust Nicholson – Medicare Beneficiary

To view our participant provider, use the link below:

Participant Providers

Home Health Agency Preferred Providers:

CenterWell Home Health: The ACO’s collaboration with CenterWell Home Health seeks to provide Original Medicare patients with access to traditional home health services while promoting a more coordinated and streamlined healthcare experience. As an affiliate of Humana, CenterWell Home Health allows for an integrated health approach, facilitating seamless communication between healthcare providers and enabling better care coordination. This collaboration aims to support patients in receiving timely, high-quality home health services while reducing fragmentation in care. With a focus on personalized care, CenterWell Home Health helps patients manage their health more effectively at home, improving overall outcomes and enhancing their quality of life. The integration of services between CenterWell ACO and CenterWell Home Health further supports a holistic, patient-centered approach to healthcare, ensuring that all aspects of a patient’s well-being are considered and addressed.

Labs and Diagnostic Preferred Providers:

Quest Diagnostics: The ACO’s collaboration with Quest Diagnostics as a preferred lab provider for CenterWell Care Solutions offers numerous benefits for both the ACO and patients. This collaboration seeks to improve access to high-quality, reliable diagnostic testing, enabling more accurate and timely care decisions. For the ACO, it enhances care coordination, streamlines lab services, and supports cost-efficiency by leveraging Quest’s extensive network and expertise. For patients, this partnership aims to improve access to essential lab services, faster results, and a seamless healthcare experience that leads to better health outcomes. Through this collaboration, CenterWell Care Solutions and Quest Diagnostics are committed to delivering more proactive, personalized care that puts patients’ needs first.

To view our preferred provider, use the link below:

Preferred Providers

CenterWell Care Solutions, Inc.

500 W. Main St.

Louisville KY 40202

866-716-5930

Questions?

If you have questions about this program, please call us at 866-716-5930. Or, you may call Medicare at 1-800-MEDICARE (1-800-633-4227; TTY users may call 1-877-486-2048). You may learn more about ACO REACH by clicking here. {ACO REACH | CMS Innovation Center}.

ACO Reach

What is an ACO (Accountable Care Organization)?

Our Continued Partnership with Medicare: ACO REACH

A Track Record of Performance

About CenterWell Care Solutions

How Medicare Beneficiaries Benefit from Being in an ACO

Performance Year Results

Join the CenterWell Care Solutions ACO

CenterWell ACO Benefit Enhancements

CenterWell ACO Clinical and Administrative Leaders

CenterWell ACO Board of Governors

Participant Providers

Preferred Providers

What is an ACO (Accountable Care Organization)?

Our Continued Partnership with Medicare: ACO REACH

A Track Record of Performance

About CenterWell Care Solutions

How Medicare Beneficiaries Benefit from Being in an ACO

Performance Year Results

Join the CenterWell Care Solutions ACO

CenterWell ACO Benefit Enhancements

CenterWell ACO Clinical and Administrative Leaders

CenterWell ACO Board of Governors

Participant Providers

Preferred Providers