Savings Calculation

  • Savings are calculated as the difference between the projected benchmark and the actual costs - The ACO is given back 50 percent of the savings.  This is an additional payment opportunity where physicians may be rewarded for improving care coordination and providing care that is appropriate, safe, and timely.

  • Each ACO has its own unique benchmark based upon the prior cost of its attributed beneficiaries.

  • The projected benchmark is based upon three factors: 
             1, Changes in the beneficiaries attributed to the ACO;
             2. Changes in the attributed beneficiaries' risk scores;
             3.The projected national increase for Medicare FFS beneficiary expenses.

PROVIDERS CONTINUE TO RECEIVE THEIR USUAL FFS PAYMENTS FROM CMS.  A PROVIDER'S PARTICIPATION IN AN ACO DOES NOT CHANGE THAT.  THIS IS AN ADDITIONAL PAYMENT OPPORTUNITY.