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REACHD0113 · PY2024 · state n/a
agilon health Pennsylvania ACO, Inc. (DBA: Senior Health Connect ACO 4)
★★★★★
quality 98/100 (XSPAN star)
Lives (aligned)
5,873
CMS revenue (total spend)
$68.4M
Benchmark
$74.5M
Shared savings earned
$6.5M
paid to the ACO by CMS (PY2024)
Savings generated
$6.5M
gross vs benchmark
Per-capita spend
$11,642
Acute admits /1k
237
ED visits /1k
518
30-day readmit rate
n/a (REACH)
Shared savings you retain / yr
$2.4M
3.6% of CMS revenue · keep 55%
FFS care-mgmt revenue / yr
$1.7M
2.5% of CMS revenue
Combined XSpan impact / yr
$4.1M
6.0% of CMS revenue
1 · Reduce avoidable utilization
From this ACO's own PY2024 utilization & unit costs. Gross avoidable cost: $3.7M/yr.
Avoidable acute admits reduced15%
$2.6M/yr
30-day readmissions reduced20%
14% national avg (not in REACH PUF)$556.9K/yr
ED visits deflected10%
$395.6K/yr
SNF admits reduced8%
$218.9K/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%$2.1M/yr
Better care → higher rating → bonus
This ACO: 5★ today. Improving quality lifts your captured shared-savings share.
Extra share from quality gains+10 pts
$373.7K/yr
Care-management codes
$891.3K
Enrollment (of eligible)30%
$/member/month$62
~1,198 enrolled (68% eligible × 30%). Requires 2+ chronic conditions (~68% of Medicare FFS). Billable alongside RPM.
$815.5K
Enrollment (of eligible)25%
$/member/month$91
~734 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.