CHESS NextGen Continues to Save Millions for Medicare Beneficiaries While Achieving High Quality

January 10, 2020

CHESS Continues to Save Millions for Medicare Beneficiaries While Achieving High Quality

CHESS works with partners to understand the needs of patient populations to change the model of health care

High Point – CHESS NextGen has saved $13.7 million in health care costs while earning an overall quality score of 97.19 percent in 2018. These financial and quality results were achieved through the Centers for Medicare and Medicaid Services Next Generation Accountable Care Organization Model.

CHESS NextGen is an accountable care organization (ACO) representing a group of over 2,700 health care providers who have come together to provide coordinated, high-quality care to the Medicare beneficiaries they serve. CHESS NextGen’s participation in 2018 was the third performance year and included the providers from Catawba Valley Medical Group, Wake Forest Health Network and Wake Forest University Health Sciences.

In the Next Generation ACO Model, a budget is set for an accountable care organization to provide care for a large group of Medicare patients. To be eligible for payment, the ACO must submit quality scores across multiple areas including patient satisfaction, disease-management, care coordination, and preventative care. If the high-quality care costs less to provide, the ACO keeps the savings. If the care costs more, the ACO will have to pay the difference. Studies have shown this model to be effective in fostering innovations in care and better patient outcomes, while generating hundreds of millions of dollars in savings.

In 2017, CHESS NextGen saved $4.3 million through this model.

CHESS NextGen is one of only 41 ACOs selected to participate in the NextGen model during the 2018 performance year. This model lets provider groups assume higher levels of financial risk and reward than are available under the current Medicare Shared Savings Program (MSSP). The goal is to provide strong financial incentives for ACOs, coupled with tools for better patient engagement and care management, and provide better health outcomes and lower cost for Medicare beneficiaries.

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