Newswise — Rush Health generated $19.8 million in cost savings for the Medicare program in the care it provided for more than 30,000 Medicare beneficiaries in the greater Chicago area in 2020, a record achievement for an Illinois academic health system.
Rush Health is Rush University System for Health’s clinically integrated network. As a participating accountable care organization (ACO) in Medicare — the federal health care insurance program for people aged 65 and over, and for the disabled — Rush Health earns a percentage of the Medicare dollars it helps the U.S. government save through the Medicare Shared Savings Program (MSSP).
The savings Rush Health achieved from Jan. 1 to Dec. 31, 2020 will result in a shared savings payment of $9.6 million back to Rush Health, which includes Rush University Medical Center in Chicago, Rush Copley Medical Center in Aurora, Rush Oak Park Hospital in Oak Park, Riverside Medical Center in Kankakee and more than 2,300 affiliated providers.
The MSSP rewards health care providers for delivering high-quality, coordinated care that achieves performance goals while simultaneously reducing Medicare costs. Rush Health’s involvement is part of a national effort to move away from traditional fee-for-service reimbursement models for health care and toward a value-based payment system that incentivizes quality and improved patient outcomes.
“At Rush, our goal isn’t simply reducing health care expenses,” explained Brian Stein, MD, chief quality officer for Rush Health. “We are dedicated to providing the highest quality care in the most cost-effective way, which ultimately allows us to reinvest in our patients and providers.”
Rush University Medical Center is the top-performing academic medical center in Chicago participating in the MSSP, a particularly notable achievement given the diverse population it serves and the specialties and complexity of care Rush Health offers.
A significant part of Rush Health’s cost savings was an 8.4% reduction in medical expenditures per capita from 2019 to 2020. The overall drop in medical expenditures was driven by reductions in skilled nursing facility expenditures per patient (-17% for Rush Health, compared to -12% for all MSSP ACOs nationwide) and in physician expenditures (-10% for Rush Health, compared to -8% nationwide).
Over the last three years, Rush Health has steadily increased its cost savings for Medicare, from 1% in 2018 to 3.4% in 2019 to 5.4% in 2020. During that span, Rush Health has saved Medicare a total of $37.5 million.
Rush Health achieved these efficiencies while at the same time increasing its quality score from 94% in 2019 to 97% in 2020. The quality score is based on performance measures ranging from preventive health checks to use of electronic health records to preventing avoidable hospitalizations.
The Centers for Medicare & Medicaid Services set a spending benchmark each year that each participating ACO must remain below in order to receive a share of their savings. The MSSP adjusted performance year benchmark for 2020 reflected a nationwide decrease in health services as a result of the COVID-19 pandemic, and Rush Health ACO’s adjusted benchmark was lower last year than in the previous two performance years.
“With the challenges we faced in 2020 as a result of the global pandemic, I couldn’t be prouder of the work we’ve done to continually deliver high-value care,” said Anthony Del Rio, president and executive director of Rush Health. “The culture of excellence at Rush shows in these results and are made possible by the doctors, nurses and other providers of Rush Health who drive quality improvement.”
Del Rio added that the shared savings will be used to reward providers for their performance, and to further develop and strengthen services such as care coordination, information technology and data analytics that support the needs of Rush Health providers.