Even as some patient care organization leaders have been asking officials at the federal Centers for Medicare & Medicaid Services (CMS) have been lobbying the agency to modify the terms under which they participate, some of the accountable care organizations (ACOs) participating in the Medicare Shared Savings Program (MSSP) have continued to demonstrate exceptional performance, as documented in the program results that were posted by the agency in August.
One of the organizations that has done exceptionally well is the Arlington, Va.-based Privia Health Group, a technology-driven, national physician enablement company that collaborates with medical groups, health plans, and health systems to optimize physician practices, improve patient experiences, and reward doctors for delivering high-value care in both in-person and virtual settings. Privia Health supports 3,800 providers caring for more than 4.4 million patients annually, in over 1,000 practice locations. Privia operates seven MSSP ACOs.
Among the top-line results published by CMS in August:
> Privia continues to be one of the leading physician lead participants in MSSP
> Privia's seven ACOs delivered total shared savings of ~$132M in the 2022 performance year, up 32 percent from 2021.
> Privia's Mid-Atlantic ACO again had the highest savings rate (10 percent) of all ACOs with 40K+ lives
> In 2022, $1.67 billion of Medicare healthcare expenses were included in Privia Quality Network, a 46.5% increase from $1.14 billion in 2021, and up from $111 million in 2014
Privia ACOs Delivered Total Annual Average Expenditures 8% Lower than Median MSSP ACO and 19% Lower than Total Fee-For-Service Medicare
$131.7 Million in Shared Savings Delivered across seven participating ACOs
On Aug. 25, Privia’s leaders posted a press release to the organization’s website that began thus: “Privia Health Group, Inc. (Nasdaq: PRVA) today announced that its Accountable Care Organizations (“ACOs”) achieved shared savings of $131.7 million through the Medicare Shared Savings Program (“MSSP”). The seven ACOs (collectively, “Privia Quality Network”) included more than 2,100 providers delivering high-value, cost-efficient care to over 163,000 Medicare beneficiaries in 2022.”
“This year’s results continue to serve as a reminder of our ACOs’ successful and replicable operating model, which is fueled by the use of our proprietary technology and team-based workflows to improve the health of our communities while aiming to decrease the total cost of care,” said Mark Foulke, Privia Health executive vice president for transformational value-based care, said in a statement included in the press release. “We’re so proud of our participating providers and their care teams who put patients first every day and focus on high quality, coordinated care to improve outcomes.”
The press release then shared the following 2022 performance highlights:
> Delivered total annual average expenditures 8% lower than the median MSSP ACO and 19% lower than total fee-for-service Medicare;
> Achieved weighted average emergency room utilization 20% lower than the median MSSP ACO and 27% lower than total fee-for-service Medicare;
> Delivered weighted average outpatient facility spend 19% lower than the median MSSP ACO and 34% lower than total fee-for-service Medicare;
> Accomplished weighted average inpatient facility spend 12% lower than the median MSSP ACO and 24% lower than total fee-for-service Medicare; and
> Exceeded primary care physician (PCP) utilization by 15% compared to both the median ACO and total FFS Medicare
Keith Fernandez, M.D., chief clinical officer, added that “Privia Health's physician-led local and national governance model promotes innovation at the point of care that we believe improves both outcomes and performance, resulting in increased quality and decreased costs of care. Our success is further enhanced by physician-to-physician education, mentoring and collaboration, and the use of technology and analytics tools that take some of the burden off our practice partners.”
Further, “Since 2014, PQN has delivered total shared savings across government and commercial programs of more than $890 million, including more than $510 million through participation in the MSSP. The amount of Medicare MSSP healthcare expenses included in Privia Quality Network has grown from $111 million in 2014 to $1.8 billion in 2022,” the press release noted.
Recently, Healthcare Innovation Editor-in-Chief Mark Hagland interviewed Dr. Fernandez about the results and about Privia’s leaders’ vision for the future. Below are excerpts from that interview.
When did you join Privia?
At the very beginning of 2016.
And you had practiced clinically for a number of years prior to that, correct?
Yes, I practiced for 33 years as a gastroenterologist.
How many physicians are involved in Privia nationwide?
The number is constantly changing, but it’s about 4,000 total providers; about 60 percent of those are physicians, while the rest are allied health professionals.
Share with me your interpretation of the marquee data points around Privia’s success in the MSSP in 2022?
We have a total of seven ACOs, and three are in the enhanced track, with downside risk attached to it. The total savings are higher in the enhanced track. We saved $132 million nationwide, which was about 30 percent more than last year. We saved 8 percent on expenditures compared to other ACOs, and 19 percent compared to regular fee-for-service Medicare. And our primary care utilization is actually up 15 percent compared to others. And so you’re using more, but you’re using more of that primary care doctor, and that’s lowering other kinds of spending. And we’re number one in the MSSP program among larger ACOs in terms of savings—among those ACOs assigned to over 40,000 lives.
What have been the critical success factors for Privia?
Of course, it has involved more than one thing. It takes a team to be successful, and the first thing of course is the physicians and their practices. It requires teamwork. And when we look for partnerships, we look for doctors who want to succeed in value-based care. Many practices don’t want to do this; they’re not bad people, they’ve just been successful in fee-for-service medicine, and don’t want to change. So it’s key that we pick our partners who are interested. And this vision is a simple one: to take better care of patients, to achieve better outcomes for patients; and it’s clear that better outcomes mean healthier patients and lower costs. So the key there is engaging people in that vision.
And the second thing really is around enablement: we partner with these physicians and practices to provide them with technology that they couldn’t afford otherwise. We bring them those resources, and then in addition to that, we bring them technology that’s directed at delivering high-quality care, and making it a little easier for the doctor to do this. You can do it faster with an EMR than on paper, and our technology keeps information at the point of care, so you can see what you’ve done and haven’t done. Everyone hears about burnout: and that is taking a highly trained person and giving them a highly administrative job. Our physicians like to say, I take care of the patient, and technology and our team, take care of the administrative things.
We help practices operationally with the business elements, and with filling up their schedules. We also provide an extensive population health management program, to take care of patients like diabetics. Also, bringing them colleagues to help them, colleagues who are more experienced.
And there’s a team around the practice team, which is still one team overall. And simple things. I’ve been doing this a long time. And people will ask about our program for heart failure patients, or this or that. The problem is that some of the programs might work, but they’re not easy to operate. Programs really are very difficult to implement consistently. But giving patients access to care when a patient wants to be seen, and where and how they want to be seen, sometimes virtually—and when we know they need to be seen. And the higher engagement has resulted in 15 percent-higher primary care utilization, which we’re glad for, as we think it correlates with better outcomes.
I’m imagining that you make extensive use of dashboards, both physician performance dashboards, and dashboards that give physicians all the data they need on their patient panels?
Yes, we do, in the normal course of business. One example: our team meets with every practice once a month, to go over their actual data. And then we bring them resources to support them. Second, we do pod meetings, with operational people, data people, and physicians, and they meet on a regular basis—every two or three months in most markets. And this is groups of physicians and their staffs. This engages everyone, including people like medical assistants. We’ve recently implemented retreats, and instead of a pod, a regional orchestration, this is a market organization, so people from all different parts of the market come together. And we take the people who are making As, and put them with the people scoring Cs. And at first, they say, wait a minute—assigned seating? And these things have been phenomenally positive. There’s excitement in the room, with the teaching experience from one practice and the learning experience from the other. And operational consultants meet with doctors on a day-to-day basis.
And one of the important differentiators for Privia, compared to organizations with just ACOs, or Medicare Advantage, is we help them with every aspect of their practices, including commercial, Medicare, Medicare Advantage, and specialty programs. In fact, we’re about to launch a downside risk program in the OB/gyn area. Our line of business is the whole practice of the medical group.
And we developed a national physician advisory council, and the clinical leadership development program, and that puts them through very significant leadership development. A pod leader called me up and said, “What happened to Dr. X? He was in a pod meeting, and was engaging the entire group differently!” A lot of this involves helping people to listen to people. And in the second year, we added some nurse practitioners; in the future, NPs and PAs will be critical to our success as a healthcare system. And how do we mix and match the people who can make this happen? So this has been a phenomenal success.
Physician culture is changing, yes? I’ve been covering it for decades, and it seems clear that practicing physicians are actively engaging now with value-based care delivery and contracting. And that requires strong leadership and management, and support, to help them get there.
I think you’re exactly right. Here’s a made-up clinical example: I don’t go tell a neurosurgeon and say to that neurosurgeon, “I have a headache, and you have to do these three things for me.” I go to the neurosurgeon and say, “I have a headache, and you have to figure it out.” In other words, the main thing is that if you tell physicians what to do, it doesn’t work; if you engage with them and let them sort it out, you can be successful. We put together a video that speaks to our culture. So it’s about bringing the physicians together to talk to each other, and bringing them a vision, and leading to success. You have to improve outcomes and take the burden off the doctors, and you’ve got to win—be successful in these contracts. And “win” means you took better care of your patients.
