St. Luke's Controls Costs and Saves Medicare Almost $20 Million

BETHLEHEM, Pa., Oct. 7, 2021 /PRNewswire/ -- St. Luke's University Health Network shared $18.6 million in savings with the Federal Government as a reward for controlling costs while providing the highest possible quality medical care to Medicare patients in 2020.

On Monday, St. Luke's was paid one-half of its savings, or $9.2 million, because it achieved a 100% quality score while providing cost-effective care to older and disabled patients in 2020.

St. Luke's is the only health network in the Lehigh Valley in 2020 to achieve both a perfect quality score and earn a payment from the Medicare Shared Savings Plan (MSSP), which is administered by the Centers for Medicare & Medicaid Services (CMS). News of the landmark achievement was published in a recent year-end report.

"St. Luke's achieved this remarkable accomplishment by keeping costs lower than expected even as it delivered the highest quality care," says Ken Berkta, MD, Family Physician and Vice President of Clinical Integration at St. Luke's.

An accountable care organization (ACO) comprises health care providers who come together voluntarily to provide high-quality, cost- efficient care to Medicare and Medicaid patients. St. Luke's formed its ACO includes more than 1,700 physicians and advanced practitioners, serving 45,000 Medicare patients who selected primary care physicians participating in the ACO.

In 2020, Medicare's benchmark or expected cost of care of patients in the St. Luke's network, after adjustment for the impact of the COVID-19 pandemic, was $470 million. The actual cost of care to Medicare was $451 million for a savings of over $18 million. The network attained a perfect quality score of 100% even during the pandemic when it was difficult to maintain preventive care testing like breast cancer and colorectal cancer screenings for much of the year because of the COVID shutdown.

St. Luke's initiatives that improved care while reducing costs include the following:

• Proactive care management services driven by artificial intelligence (AI) analytical tools to identify patients at higher risk for poorer outcomes
• Use of evidence-based, patient-centric clinical protocols developed by physicians and other clinical leaders across the spectrum of care including hospital, outpatient, home care, and skilled nursing facilities
• Real-time clinical decision support tools in the electronic health record to aid in the ordering of the most cost-effective tests
• Focus on preventive care services and other initiatives to reduce avoidable hospitalizations and readmissions

The CMS MSSP was started in 2013 to stem the continuously increasing cost of healthcare in the U.S. while maintaining a focus on the delivery of high-quality care.

About St. Luke's
Founded in 1872, St. Luke's University Health Network is a fully integrated, regional, non-profit network of more than 17,000 employees providing services at 12 hospitals and 300 outpatient sites. With annual net revenue in excess of $2.6 billion, the Network's service area includes 11 counties in Pennsylvania and New Jersey. Dedicated to advancing medical education, St. Luke's is the preeminent teaching hospital in central-eastern Pennsylvania.

SOURCE St. Luke's University Health Network