Cleveland Clinic Tackles Downside Risk in Medicare ACO
The health system is confident of success based on performance in its first Medicare ACO contract as well as recent improvements in care coordination, skilled nursing partnerships, and care access.
Cleveland Clinic is taking on downside risk in the Medicare Shared Savings Program, shifting from the upside-only Track 1 of the program to Track 1+.
"The migration toward risk is something we realize is happening across northeast Ohio and the country," says James Gutierrez, MD, president and medical director of Cleveland Clinic Medicare ACO. "We know that we need to be ready to embrace greater risk and we need to be ready to do it successfully if we are going to survive as an organization."
Cleveland Clinic Medicare ACO, which manages a population of 105,000 beneficiaries, participated in MSSP Track 1 from 2015 to 2017 and posted strong financial performance. In 2016, the ACO achieved $42.2 million in savings, which was a 24.5% increase over 2015 performance. Also in 2016, the ACO received $19.9 million back from MSSP in shared savings, a 19.8% increase over 2015.
In its three-year MSSP Track 1+ contract that starts this year, Cleveland Clinic Medicare ACO faces a 30% loss-sharing rate if the ACO fails to meet its spending benchmark and as high as a 50% gain-sharing rate.
In addition to its strong performance in MSSP Track 1, Gutierrez says the health system expects to perform successfully in Track 1+ because of recent capability improvements in care coordination, post-acute care, and patient access.
He says the 11-hospital health system took a major step toward improved care coordination last fall, with the launch of Cleveland Clinic Community Health.
"Although we talk about one Cleveland Clinic and we are a unified enterprise, there are two populations that we serve," he says. "One is the regional, national and international referral base that we serve for tertiary care, the other is a large segment of the local population in northeast Ohio."