OSF ACO continues strong quality performance, reduces Medicare costs

As part of the work to ensure the best possible health outcomes for patients while also reducing health care costs, OSF HealthCare has been an Accountable Care Organization (ACO) under the Centers for Medicare & Medicaid Services (CMS) since 2012. OSF is pleased to announce our 2021 quality score of 90.96%.

This quality score means that OSF achieved an “A” in terms of the positive health outcomes delivered for patients, and it’s based on the metrics of a random sample of the nearly 43,000 Medicare patients served by the OSF ACO. These results are then measured against the performance of other ACOs, including meeting certain care and documentation provisions. 

“This quality score is especially noteworthy because we were able to sustain our efforts despite serving more patients with fewer resources, such as personnel and operating margin, during the COVID-19 pandemic,” said Ralph Velazquez, MD, chief medical officer of OSF HealthCare. “While we spent the last decade improving our quality for all populations we serve – both Medicare and non-Medicare patients, our key challenge now is to not only maintain that A grade, but to keep improving on these results, which already exceed the vast majority of health care systems.”

An ACO is a group of doctors, hospitals and other health care providers who come together to provide coordinated care to their patients. This ensures that patients, especially the chronically ill, get the right care at the right time while avoiding unnecessary duplication of services and preventing medical errors.

When an ACO succeeds in delivering high-quality, evidence-based care that leads to improved health outcomes at a lower cost, the ACO shares in the savings it achieves for the Medicare program. In fiscal year 2021, OSF HealthCare saved taxpayers $28 million more than the benchmark set by CMS and, as a result, will receive a payback of $20.6 million, which will be reinvested into patient care.

“Two of the key ways we deliver value-based care and high-quality results are through coordinated care and comprehensive primary care in collaboration with our specialty care clinics. This includes embedding care managers and behavioral health specialists to provide extra care for patients who need it,” added Dr. Velazquez.

OSF was selected as one of the first Pioneer ACOs in 2011 because the work fits the philosophy and mission of OSF HealthCare for improved quality, care coordination and decreased cost for all patients served. Like other leading health care systems, OSF believes that focusing and performing well on quality measures will help to keep health care affordable by reducing or slowing the rise in costs.