Value-Based Care in Action: Real Results by Real Physicians

November 1, 2021

In 2020, in spite of headwinds from the COVID-19 pandemic, independent primary care practices in our physician-led ACOs used the tools and resources we provided them to more than double their shared savings revenues, earning an average of $198,000 each for delivering the highest quality of care to their patients in the Medicare Shared Savings Program (MSSP).

The most critical key to their success was a committed focus on delivering core preventive care services to their patients. Called the “Core 4” by our ACOs, these services are centered on the delivery of Annual Wellness Visits (AWVs); Emergency Department (ED) follow-up and outreach; Transitional Care Management (TCM); and diagnosis documentation.

To help practices deliver on these Core 4 elements, we provide the tools for they need for success, including:

For two clinicians in our ACOs, these tools proved critical to achieving financial success for their practices and improved outcomes for their patients in the midst of a global pandemic.

A Successful Pivot for Real Results: The Real Experiences of Ray Kusumoto, MSH, PA-C
A primary care group located in rural Hollister, California, Primary Care Associates is associated with its local Critical Access Hospital and has four locations with seven healthcare providers. When the practice joined Aledade in 2020, it had had no real experience with shared savings. 

“At that point, COVID hit, and we were not as well engaged as I think we should have been with shared savings,” said Ray Kusumoto, CEO. “Then there were the distractions of trying to help with the local reaction to the COVID pandemic. Our attention was very much off of shared savings for the first part of 2020, so we were kind of behind the eight ball and behind on our reporting.”

As the summer went on and the practice received support from Aledade in areas like telehealth implementation, the practice was able to successfully pivot to the value-based care model. In January 2020, for example, the practice’s AWVs stood at just 7 percent; by December of the same year, 61 percent of patients had received an AWV. Similarly, diagnosis coding improved from zero percent to 79 percent; TCM increased from zero to 26 percent; and ED utilization decreased by 10 percent. 

Ultimately, with Aledade’s support and a dedicated focus on preventive care delivery, Primary Care Associates achieved shared savings in Year 1. “By December, with a lot of help and a lot of communication with Aledade, we were able to bring this forward,” said Kusumoto. “In the end, we made shared savings and it was a great benefit for our practice. The resources given to us by Aledade helped us manage not just our Medicare population, but all of our patients, including our commercial patients.”

Taking the Scenic Route to Real Results: The Real Experiences of Nibha Mediratta, MD
In Clermont, Florida, practice owner Dr. Nibha Mediratta also found success in value-based care, despite the headwinds of a global pandemic. Her practice, located near Orlando, has one location, one physician, and two APRNs, and serves approximately 700 Medicare patients.

“I was a hospitalist about 10 or 12 years ago, and when I came into private practice, a lot of talk about fee-for-service and shared savings and skyrocketing Medicare costs is what led us to explore into Accountable Care Organizations,” explained Dr. Mediratta. “I have been in an ACO, on and off, for almost 10 years now.”

Her practice initially joined Aledade in 2012, only to leave for another ACO. Her practice returned to Aledade for Performance Year 2020. “We returned to Aledade mainly because of the Aledade App platform, the data presentation and the support we got through that platform,” she said. “The data presentation and the support that was offered did improve my quality of care, my ability to catch ED visits, the hospital follow-ups, and the diagnosis and risk scoring to a point where we made big improvements in our shared savings for 2020.“

Dr. Mediratta utilized the Aledade App to identify patients in need of AWVs and make outreach to those patients, ultimately delivering AWVs to 93 percent of attributed patients by December 2020, in spite of the pandemic. In addition, the practice resolved 88 percent of diagnoses; completed 60 percent of TCMs; and achieved an impressive ED outreach rate of 96 percent.

“I am one of those practices that left Aledade, only to come back because this platform works best for me as a small independent practitioner to stay independent, and enable me to do both fee-for-service and get rewarded for my quality,” she explained. 

Listen as Ray Kusomoto, MHA, PA-C, and Dr. Nibha Mediratta share their real experiences with Dr. Jen Brull, Aledade VP of Clinical Engagement, in a recent webinar, and then take a moment to calculate your practice’s potential shared savings revenues as a member of an Aledade ACO.

Ready to take the next step? Click here to book a meeting and learn how Aledade can meet your practice’s unique goals.