SLUHN Controls Costs and Saves Medicare Almost $20 Million

St. Luke’s University Health Network (SLUHN) shared $18.6 million in savings with the Federal Government as a reward for controlling costs while providing the highest possible quality medical care to Medicare patients in 2020.

On Monday, St. Luke’s was paid one-half of its savings, or $9.2 million, because it achieved a 100% quality score while providing cost-effective care to older and disabled patients in 2020.

St. Luke’s is the only health network in the Lehigh Valley in 2020 to achieve both a perfect quality score and earn a payment from the Medicare Shared Savings Plan (MSSP), which is administered by the Centers for Medicare & Medicaid Services (CMS). News of the landmark achievement was published in a recent year-end report.

“St. Luke’s is proud to have earned the distinction of being the only health care network in the Lehigh Valley to earn a MSSP payment,” says Ken Bertka, MD, Family Physician and Vice President of Clinical Integration at St. Luke’s. “St. Luke’s achieved this remarkable accomplishment by keeping costs lower than expected even as it delivered the highest quality care. This is all the more impressive considering it took place amid a pandemic.”

An accountable care organization (ACO) comprises physicians, nurse practitioners, physician assistants, other clinicians, as well as hospitals and other healthcare facilities who come together voluntarily to provide high-quality, cost- efficient care to Medicare and Medicaid patients.

St. Luke’s formed its ACO in 2018 and includes more than 1,700 physicians and advanced practitioners, both employed by SLUHN and independent community offices, serving 45,000 Medicare patients who selected primary care physicians participating in the ACO.

“This much-deserved recognition and shared-savings reflects our providers’ commitment to collaboration and evidence-based medicine as we strive to provide the right care at the right cost in the right place and at the right time,” adds Linda Gately, St. Luke’s Vice President Quality, Performance, and Compliance.

In 2020, Medicare’s benchmark or expected cost of care of patients in the St. Luke’s network, after adjustment for the impact of the COVID-19 pandemic, was $470 million. The actual cost of care to Medicare was $451 million for a savings of over $18 million. The network attained a perfect quality score of 100% even during the pandemic when it was difficult to maintain preventive care testing like breast cancer and colorectal cancer screenings for much of the year because of the COVID shutdown.

St. Luke’s initiatives that improved care while reducing costs include the following:

• Proactive care management services driven by artificial intelligence (AI) analytical tools to identify patients at higher risk for poorer outcomes
• Use of evidence-based, patient-centric clinical protocols developed by physicians and other clinical leaders across the spectrum of care including hospital, outpatient, home care, and skilled nursing facilities
• Real-time clinical decision support tools in the electronic health record to aid in the ordering of the most cost-effective tests
• Focus on preventive care services and other initiatives to reduce avoidable hospitalizations and readmissions

The CMS MSSP was started in 2013 to stem the continuously increasing cost of healthcare in the U.S. while maintaining a focus on the delivery of high-quality care. Benchmarks for the MSSP include both expected total cost of care, based on the complexity of the population served, and quality measures compared to peer providers.

Last year was St. Luke’s third year as a participant in the MSSP. “Our performance improved each year. In 2018, we held the total cost of care at the benchmark. In 2019, we realized savings of 1.9 percent or $9.5 million. Last year, our savings was almost 4 percent lower than benchmark. Saving $18 million on the total cost of care and achieving high-quality outcomes is a testament to St. Luke’s focus on high-value care,” says Chris Lewis, MPH, RN, Executive Director of the ACO.

According to a news release from the National Association of ACOs, Medicare Shared Savings Programs served 10.6 million seniors and saved a total of $4.1 billion nationwide in 2020, the highest annual savings to date by this program.