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MSSPA5192 · PY2024 · serves 5 states
Lore Health ACO LLC
Met CMS quality standard
CMS assigned a default reporting score (shared by ~35 ACOs) — not individually star-rated.
Lives (aligned)
13,369
CMS revenue (total spend)
$225.4M
Benchmark
$238.7M
Shared savings earned
$9.8M
paid to the ACO by CMS (PY2024)
Savings generated
$13.3M
gross vs benchmark
Per-capita spend
$17,275
Acute admits /1k
274
ED visits /1k
672
30-day readmit rate
15.8%
Service area CA, FL, NH, NM, VTOperator Mark Briesacher
Shared savings you retain / yr
$7.7M
3.4% of CMS revenue · keep 55%
FFS care-mgmt revenue / yr
$3.9M
1.7% of CMS revenue
Combined XSpan impact / yr
$11.6M
5.2% of CMS revenue
1 · Reduce avoidable utilization
From this ACO's own PY2024 utilization & unit costs. Gross avoidable cost: $11.9M/yr.
Avoidable acute admits reduced15%
$8.1M/yr
30-day readmissions reduced20%
on 15.75% measured rate$2M/yr
ED visits deflected10%
$1.1M/yr
SNF admits reduced8%
$654.5K/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%$6.5M/yr
Better care → higher rating → bonus
This ACO: not individually rated. Improving quality lifts your captured shared-savings share.
Extra share from quality gains+10 pts
$1.2M/yr
Care-management codes
$2M
Enrollment (of eligible)30%
$/member/month$62
~2,727 enrolled (68% eligible × 30%). Requires 2+ chronic conditions (~68% of Medicare FFS). Billable alongside RPM.
$1.9M
Enrollment (of eligible)25%
$/member/month$91
~1,671 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.