SIMEDHealth ACO Saves Medicare over $2 million!

Thanks to the hard work of our Integrated Care Alliance team, we saved Medicare over $2 million in 2017! This announcement comes after Medicare released it's 2017 expenditure reports. The report also details quality scores. This is the third year in a row that SIMEDHealth has received a quality score above 90 percent.

GAINESVILLE, FL -- Medicare recently made public the 2017 expenditures and quality reports for their Accountable Care Organizations (ACOs) and the Integrated Care Alliance had beneficiary expenditures below Medicare’s targeted benchmark.  The Integrated Care Alliance (ICA) is one of 472 Medicare ACOs around the country and is the ACO of SIMEDHealth, LLC.  Through the ICA’s work with its Medicare population of 6,218 it was able to produce a composite quality score of 92.06%, and savings to Medicare of $2,031,672.

 “It is exciting to see our years of efforts to improve this region’s patient care while controlling cost is quite literally paying off for Medicare,” says Beth Keane, Chief of Population Health at SIMEDHealth.  

2017 was the third year in a row the ICA has produced a composite quality score above 90%.  The quality score is compiled from thirty-two different measures including surveys of patients about their health care experiences, and information obtained from medical documentation submitted to Medicare.  The ICA has seen year-over-year improvement in many quality measures and is proud of the patient experience surveys showing it achieved the 90th percentile for patients’ rating of how well their physician communicates, health promotion and education, shared decision making, and their overall rating of their physician.

Medicare savings are determined based on the previous year’s cost experiences for the ICA’s patient population, as well as the comparison on the overall health of this population versus the national and regional Medicare patients’ health status.  The ICA population’s total Medicare expenditures for the year were two million dollars less than predicted by Medicare.   However, because these Medicare savings did not exceed a previously targeted percentage of savings Medicare retains all of the savings without sharing it with the ICA.

The ICA and the Medicare ACO program were started in 2012 to improve the collective effort of doctors, hospitals, and other healthcare providers to provide higher quality, coordinated care.  The higher quality of care meets measurable quality standards, with a goal of being satisfying to the patients, and to reduce the total costs of health care.  The ICA care team focuses on case management, care coordination, data analysis, and coding to assist SIMEDHealth physicians to provide coordinated care and education for their patients.

Keane believes the team’s success is a result of excellent physicians.  “The key is our primary care physicians and advanced care practitioners focusing on prevention, wellness and carefully managing chronic disease. Through their efforts along with a care team providing highly coordinated and individualized care, we aim to reduce unnecessary hospital admissions, emergency room visits, and spending, all while improving patient care.”

Dr. Daniel Duncanson, Chief Executive Officer of SIMEDHealth and the ICA believe this is what true health care should be about.  “In the ACO, we do better when we help our patients stay healthier.  Getting information and education to our physicians and patients so better health choices are made is what we’re motivated to do.  While we’re disappointed we didn’t cross the line that allows Medicare to share a portion of the savings with us we know we’re on the right trajectory.  It’s the trajectory we all need our health care providers and facilities aiming for if we’re ever going to improve our national health care and get costs under control.”  

In 2017 the ICA participants were Southeastern Integrated Medical, P.L. (SIMED) and James McCauley, M.D., P.A.  SIMED developed a new health care system, SIMEDHealth, L.L.C. in April of 2018 by combining with the Digestive Disease Associates of North Florida, Inc.  SIMEDHealth has clinics in several locations in Gainesville, and in Ocala, Chiefland, Lake City, and Lady Lake/The Villages.