UHS ACOs Saved Medicare $82.2 million in 2021


Media Contact: Jane Crawford, Universal Health Services 610-382-4830 | jane.crawford@uhsinc.com

Amy Beck, Prominence Health Plan 775-742-9424 | Amy.Beck@uhsinc.com

UHS ACOs Saved Medicare $82.2 million in 2021

With its seven ACOs across five U.S. states and the District of Columbia, Prominence Health Plan continues to produce meaningful cost savings to Medicare, while providing value-based care to patients, and financial rewards to its participating physicians.

RENO, NV (Oct. 6, 2022) — Prominence Health Plan, a subsidiary of Universal Health Services (NYSE: UHS), announces its 2021 ACO results with more than $82 million in savings to Medicare and more than $56 million in earnings for its 3,000 participating physicians. This yields nearly $400 million in savings since the establishment of the first UHS ACO in 2014.

"This success is an amazing testament to our provider's committment to their patients," said Kamal Jemmoua, CEO, Prominence Health Plan. "The growth we've seen this year has allowed us to create higher impact within the communities UHS serves. We are extremely proud of our physician and provider partners, care management teams and support staff, who continue to focus on the quality of the patient experience and providing exceptional care."

ACOs are groups of physicians who agree to reduce costs and increase quality within a value-based contract, which results in a shared savings agreement. Physicians are incentivized and given better tools to bend the healthcare cost curve, manage utilization, and maintain high-quality care. This is due to both shifting from volume-based payments to value-based payments and better integrating data and communication between providers, patients, specialists, and hospital systems. Within the shared savings program, providers can earn back part of the savings they generate for Medicare by hitting pre-determined spending goals.

“The healthcare industry has been slow to transform away from fee-for-service, but value-based care and the ACO models have provided a guideline to focus on the delivery of high-quality patient care and outcomes within the primary care setting,” said Dr. Monzer Yazji, South Texas Clinical Partners ACO. “Primary care providers (PCP) have realized they are at the center of value-based patient management and leadership. We continue to grow, learn and embrace the dynamics of preventative care and personalized medicine.”

Unlike the traditional ACO model, UHS ACOs are physician-led but sponsored either wholly by UHS or in a joint-venture partnership with ACO participants. These organizations are centered on primary care with community partnerships in post-acute and specialty care. Hospital sponsorship is a differentiator in UHS ACOs as the hospitals partner with providers to provide capital funding, invest in tools to better manage downside risk, and integrated ACO-friendly hospital initiatives focused on avoiding unnecessary utilization and increasing communication with ACO providers. The support from UHS facilities allows for ACO leadership and governance to be driven by participating providers in the community – a vital component to success in value-based care.

UHS also provides administrative oversight and data analytics for ACO operations in addition to ACO-friendly hospital initiatives within each UHS facility. These initiatives include PCP notification of ACO beneficiary admit/discharge, ACO patient flags within the hospital electronic medical record (EMR), partnerships with hospitalists and emergency deparement providers to ensure appropriate utilization, and integrated case management navigating PCP communication and post-acute care.

UHS ACO Highlights:• Silver State ACO: Ranked #1 ACO in the state of Nevada for total savings at $34 million and achieved a savings rate at 7% below the benchmark • California Clinical Partners ACO: Ranked #1 ACO in the state of California for total earnings at $21 million with a savings rate at 13% below the benchmark • Texoma Clinical Partners: Ranked 2nd for highest quality score in the region • South Texas Clinical Partners: Ranked in the top 5 in the state of Texas for savings rate at 9.5% below benchmark with $9.5 million in total savings • DOC ACO: One of only 34 in the nation to achieve a 100% quality score

"Our patients are at the center of everything we do. Since launching in 2019, Texoma ACO has generated shared savings for three consecutive years, demonstrating a commitment from our primary care providers, partnered health system, and partnered post-acute network in practicing value-based medicine, said Robert Sanders, MD, TexomaCare. “Our team is dedicated to shifting how medicine is practiced in our community from reactive to preventive medicine to improve the patient experience and reduce the financial burden of care to Medicare.”

The Center for Medicare and Medicaid Services established the ACO program to improve the quality of care for Medicare beneficiaries and lower Medicare costs. If an ACO achieves high quality and saves money for Medicare, then the ACO shares in those savings. Since the beginning of the ACO program in 2013, ACOs have saved Medicare $6.8 billion.

About Prominence Health Plan

Prominence Health Plan began in 1993 as a health maintenance organization (HMO) and became a subsidiary of Universal Health Services, Inc. (UHS) in 2014. They provide coverage to Commercial (fully insured and self-funded), and Medicare Advantage members throughout Nevada and parts of Texas and Florida.

Prominence operates seven Accountable Care Organizations (ACOs) in California, Florida, Nevada, South Carolina, Texas, and Washington D.C., which are managed care systems that benefit communities by providing coordinated, high-quality care to Medicare patients. For more information about Prominence Health Plan, visit ProminenceHealthPlan.com or ProminenceMedicare.com.

About Universal Health Services One of the nation’s largest and most respected providers of hospital and healthcare services, Universal Health Services, Inc. (NYSE: UHS) has built an impressive record of achievement and performance. Growing steadily since our inception into an esteemed Fortune 500 corporation, our annual revenues were $10.77 billion during 2018. In 2019, UHS was again recognized as one of the World’s Most Admired Companies by Fortune; ranked #293 on the Fortune 500; and in 2017, listed #275 in Forbes inaugural ranking of America’s Top 500 Public Companies.

Our operating philosophy is to provide compassionate care to our patients and their loved ones. Our strategy includes building or acquiring high-quality hospitals in rapidly growing markets, investing in the people and equipment needed to allow each facility to thrive, and becoming the leading healthcare provider in each community we serve.

Headquartered in King of Prussia, PA, UHS has more than 87,000 employees and through its subsidiaries currently operates 26 acute care hospitals, 328 behavioral health facilities, 40 outpatient facilities, and ambulatory care access points, an insurance offering, a physician network and various related services located in 37 U.S. states, Washington, D.C., Puerto Rico and the United Kingdom. It acts as the advisor to Universal Health Realty Income Trust, a real estate investment trust (NYSE:UHT). For additional information on the Company, visit our web site: www.uhsinc.com.