Medicare patients in SC are seeing care improve and overall healthcare costs decline due to Southeastern Health Partners

New report shows efficiencies, improvement in quality and reductions in cost

When a group of hospitals, doctors, and other healthcare clinicians joined a new Medicare collaboration in South Carolina, serving tens of thousands of people, they had two main goals:

• Provide patients the best quality care.
• Reduce costs by helping sick patients stay healthier and keep healthy people from getting sick.

The 2017 Medicare report is in, and the program worked wonders. The Southeastern Health Partners (SEHP) collaboration of 11 hospitals and 2,000 providers cut Medicare costs in South Carolina by $7.4 million.

The Accountable Care Organization (ACO) also achieved 100 percent in quality, according to a 2017 CMS report.

SEHP, in its first year of operation, became the largest Medicare Shared Savings Program (MSSP) ACO in South Carolina – based on the total number of Medicare members attributed to providers in the program. The Centers for Medicare & Medicaid Services (CMS) has approximately 500 ACOs, serving more than 9 million Medicare beneficiaries nationwide.

CMS rewards SEHP for improving quality of care and reducing costs. The CMS report shows that Southeastern Health Partners’ providers are more efficient than other providers in the region and state.

Southeastern Health Partners ended 2017 with a savings rate of 1.5 percent, resulting in $7.4 million in total savings on its Medicare population. SEHP’s success is particularly notable given its already low benchmark cost. This means that before starting to cut costs, SEHP providers had lower costs per Medicare patient than most other providers. Then SEHP providers cut costs even more. They showed they could meet tight financial goals while improving quality care for Medicare patients.

CMS uses Accountable Care Organization and MSSP models to lower Medicare spending and keep the Medicare program sustainable for the long term. Success depends on hospitals, physicians and other clinicians encouraging patients to maintain their health through better habits – including taking medication as prescribed — in order to prevent unnecessary emergency room visits and preventable hospitalizations.