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MSSPA4979 · PY2024 · serves 1 state
ProHealth Solutions, LLC
★★★★☆
quality 80.3/100 (XSPAN star)
Lives (aligned)
13,410
CMS revenue (total spend)
$164.2M
Benchmark
$163.1M
Shared savings earned
-$443K
paid to the ACO by CMS (PY2024)
Savings generated
-$1.1M
gross vs benchmark
Per-capita spend
$12,458
Acute admits /1k
285
ED visits /1k
654
30-day readmit rate
14.6%
Service area WIOperator Peter Bacon
Shared savings you retain / yr
$6.3M
3.8% of CMS revenue · keep 55%
FFS care-mgmt revenue / yr
$3.9M
2.4% of CMS revenue
Combined XSpan impact / yr
$10.1M
6.2% of CMS revenue
1 · Reduce avoidable utilization
From this ACO's own PY2024 utilization & unit costs. Gross avoidable cost: $9.6M/yr.
Avoidable acute admits reduced15%
$6.6M/yr
30-day readmissions reduced20%
on 14.56% measured rate$1.5M/yr
ED visits deflected10%
$1.1M/yr
SNF admits reduced8%
$369.3K/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%$5.3M/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
$961.6K/yr
Care-management codes
$2M
Enrollment (of eligible)30%
$/member/month$62
~2,736 enrolled (68% eligible × 30%). Requires 2+ chronic conditions (~68% of Medicare FFS). Billable alongside RPM.
$1.9M
Enrollment (of eligible)25%
$/member/month$91
~1,676 enrolled (50% eligible × 25%). Device supply + 20-min treatment mgmt. Concurrent with CCM allowed.
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CY2024 national-average code rates — editable. In MSSP, care-management billing also counts toward ACO expenditures; net effect depends on your model.