MSSPA2000 · PY2024 · serves 1 state

ProHealth Physicians ACO, LLC

★★★★☆

quality 88.3/100 (XSPAN star)

Lives (aligned)

14,384

CMS revenue (total spend)

$172.9M

Benchmark

$210.6M

Shared savings earned

$18.5M

paid to the ACO by CMS (PY2024)

Savings generated

$37.8M

gross vs benchmark

Per-capita spend

$12,210

Acute admits /1k

210

ED visits /1k

626

30-day readmit rate

14.7%

Service area CTOperator Pamela George

Shared savings you retain / yr

$5.9M

3.4% of CMS revenue · keep 55%

FFS care-mgmt revenue / yr

$4.2M

2.4% of CMS revenue

Combined XSpan impact / yr

$10.1M

5.8% of CMS revenue

1 · Reduce avoidable utilization

From this ACO's own PY2024 utilization & unit costs. Gross avoidable cost: $9M/yr.

Avoidable acute admits reduced15%

$5.8M/yr

30-day readmissions reduced20%

on 14.74% measured rate$1.3M/yr

ED visits deflected10%

$1.2M/yr

SNF admits reduced8%

$790.5K/yr

ED cost per visit$1,300

2 · How MSSP pays you

FFS shared savings + separately-billable care-management codes.

Shared-savings rate you keep55%

BASIC 40% → ENHANCED 75%$5M/yr

Better care → higher rating → bonus

This ACO: 4★ today. Improving quality lifts your captured shared-savings share.

Extra share from quality gains+10 pts

$904.2K/yr

Care-management codes

Chronic Care ManagementCPT 99490$2.2M

Enrollment (of eligible)30%

$/member/month$62

~2,934 enrolled (68% eligible × 30%). Requires 2+ chronic conditions (~68% of Medicare FFS). Billable alongside RPM.

Remote Patient MonitoringCPT 99453 / 99454 / 99457$2M

Enrollment (of eligible)25%

$/member/month$91

~1,798 enrolled (50% eligible × 25%). Device supply + 20-min treatment mgmt. Concurrent with CCM allowed.

Remote Therapeutic MonitoringCPT 98977 / 98980—

Wearable Device ReimbursementCPT 99454 (device supply)—

CY2024 national-average code rates — editable. In MSSP, care-management billing also counts toward ACO expenditures; net effect depends on your model.