REACHD0242 · PY2024 · state n/a

Pearl Primary Care Network, LLC

★★★★★

quality 93/100 (XSPAN star)

Lives (aligned)

62,577

CMS revenue (total spend)

$953.4M

Benchmark

$956.1M

Shared savings earned

$3M

paid to the ACO by CMS (PY2024)

Savings generated

$6.1M

gross vs benchmark

Per-capita spend

$15,235

Acute admits /1k

268

ED visits /1k

699

30-day readmit rate

n/a (REACH)

Shared savings you retain / yr

$35.7M

3.7% of CMS revenue · keep 55%

FFS care-mgmt revenue / yr

$18.2M

1.9% of CMS revenue

Combined XSpan impact / yr

$53.9M

5.7% of CMS revenue

1 · Reduce avoidable utilization

From this ACO's own PY2024 utilization & unit costs. Gross avoidable cost: $55M/yr.

Avoidable acute admits reduced15%

$36.5M/yr

30-day readmissions reduced20%

14% national avg (not in REACH PUF)$7.9M/yr

ED visits deflected10%

$5.7M/yr

SNF admits reduced8%

$4.8M/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%$30.2M/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

$5.5M/yr

Care-management codes

Chronic Care ManagementCPT 99490$9.5M

Enrollment (of eligible)30%

$/member/month$62

~12,766 enrolled (68% eligible × 30%). Requires 2+ chronic conditions (~68% of Medicare FFS). Billable alongside RPM.

Remote Patient MonitoringCPT 99453 / 99454 / 99457$8.7M

Enrollment (of eligible)25%

$/member/month$91

~7,822 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.