MSSPA5279 · PY2024 · serves 1 state

Sutter Preferred Direct Contracting Entity LLC

★★☆☆☆

quality 69.3/100 (XSPAN star)

Lives (aligned)

125,041

CMS revenue (total spend)

$1.9B

Benchmark

$1.8B

Shared savings earned

-$3.3M

paid to the ACO by CMS (PY2024)

Savings generated

-$11M

gross vs benchmark

Per-capita spend

$15,080

Acute admits /1k

207

ED visits /1k

559

30-day readmit rate

13.8%

Service area CAOperator Gregory Montemayor

Shared savings you retain / yr

$65.2M

3.5% of CMS revenue · keep 55%

FFS care-mgmt revenue / yr

$36.3M

2.0% of CMS revenue

Combined XSpan impact / yr

$101.5M

5.5% of CMS revenue

1 · Reduce avoidable utilization

From this ACO's own PY2024 utilization & unit costs. Gross avoidable cost: $100.3M/yr.

Avoidable acute admits reduced15%

$65.7M/yr

30-day readmissions reduced20%

on 13.83% measured rate$14.1M/yr

ED visits deflected10%

$9M/yr

SNF admits reduced8%

$11.6M/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%$55.2M/yr

Better care → higher rating → bonus

This ACO: 2★ today. Improving quality lifts your captured shared-savings share.

Extra share from quality gains+10 pts

$10M/yr

Care-management codes

Chronic Care ManagementCPT 99490$19M

Enrollment (of eligible)30%

$/member/month$62

~25,508 enrolled (68% eligible × 30%). Requires 2+ chronic conditions (~68% of Medicare FFS). Billable alongside RPM.

Remote Patient MonitoringCPT 99453 / 99454 / 99457$17.4M

Enrollment (of eligible)25%

$/member/month$91

~15,630 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.