Baylor Scott & White Quality Alliance Saves $68 Million in Medicare Shared Savings Program, Attains Top Quality Score

Highest savings in the nation generated for Medicare after shifting to downside risk

DALLAS, Texas  Baylor Scott & White Quality Alliance, Baylor Scott & White Health's accountable care organization (ACO), generated $68 million in savings in the Medicare Shared Savings Program (MSSP) in 2019.

The MSSP is an alternative payment model in which eligible healthcare providers, hospitals and suppliers are rewarded for achieving better health for individuals, improving population health and lowering healthcare costs. In 2019, ACOs in the MSSP saved a record-breaking $1.2 billion.

According to results released by the Centers for Medicare & Medicaid Services (CMS), Baylor Scott & White Quality Alliance generated the highest savings in the nation among participants who entered the Pathways to Success downside risk model from July to December 2019.

These savings were achieved while the organization continued to make strides in improving quality, and in calendar year 2019, Baylor Scott & White Quality Alliance earned a quality score of 98.4%.

"Our 2019 results demonstrate our continued commitment to making healthcare better and more affordable through provider-led care coordination and design," said Laura Irvine, chief network strategy officer, Baylor Scott & White Health. "For the second year in a row, we have delivered significant savings for Medicare; in fact, after we began taking downside risk in July 2019, our work generated the highest savings in the nation. As the largest clinically integrated network in Texas, we are proud to have achieved not only the highest savings in the state, but also one of the highest quality scores."

Savings in 2018 led to innovations in 2019

In addition to providing quality care for all patients, Baylor Scott & White began in 2018 connecting those identified as high-risk with a member of its Comprehensive Care Management team to offer disease management, health coaching, and other services. The savings achieved through MSSP in 2018 allowed Baylor Scott & White to extend this care coordination to the full population of Medicare beneficiaries that are part of the program. 

One of the interventions that Baylor Scott & White launched for the 2019 plan year was a pharmacy team that assisted patients with medication reconciliation, medication adherence, refills and more.

Within the MSSP population, Baylor Scott & White Quality Alliance saw several notable improvements in performance:

  • Based on the most recent data, post-acute care utilization per 1,000 beneficiaries decreased: 1.3% for inpatient rehabilitation and 12.3% for long-term acute care hospitalization.  
  • Hospital readmissions decreased 1.9%.
  • Emergency department visits per 1,000 beneficiaries decreased 3.4%
  • Primary care usage increased 3.6%.

"Our collective commitment to helping our patients receive cost-effective, quality care involves engaging the physician members of Baylor Scott & White Quality Alliance, along with our nurse care managers, social workers, and pharmacists to offer robust care options," said Tiffany Berry, MD, chief medical officer, Baylor Scott & White Quality Alliance. "Our clinical team members were crucial in developing ways to better serve our patients – including expanding our hours and providing more convenient appointment types, which allowed us to spend more time with each patient."

Entering the Pathways to Success downside risk model

Having refined its integrated care model with a focus on comprehensive care management, data analytics, and physician engagement, Baylor Scott & White Quality Alliance moved into the Pathways to Success model that was established in December 2018. The program is intended to improve the accuracy of financial benchmarks and strengthen the incentive for ACOs to sustainably drive down spending over the long run.

"Moving into a more challenging version of this program – one that could help make Medicare more sustainable for the communities we serve for years to come – fits in with our commitment to changing healthcare for the better," said Jenny Reed, vice president, Baylor Scott & White Quality Alliance. "Now, as one of the largest program participants in the nation, we are intentional about innovating our offerings to lower costs while keeping quality at the forefront for our enrolled 130,000 Medicare beneficiaries. Our confidence in the program, investment in high-quality and efficient services and development of significant and lasting innovations help us to continue delivering savings year after year."  

Baylor Scott & White Quality Alliance is the largest clinically integrated network in Texas. Since 2013, Baylor Scott & White Quality Alliance has refined its integrated care model, which encompasses comprehensive care management, data analytics, physician engagement and clinical excellence. Baylor Scott & White’s experience delivering integrated care management, virtual health and an exceptional member experience started first with its own employee population. Now, Baylor Scott & White Quality Alliance provides value-based care to over 750,000 lives, saving more than $200 million across 13 value-based contracts.

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About Baylor Scott & White Health
As the largest not-for-profit health system in the state of Texas, Baylor Scott & White Health promotes the health and well-being of every individual, family and community it serves. An integrated care delivery network, the system includes the Scott and White Health Plan, Baylor Scott & White Research Institute and Baylor Scott & White Quality Alliance. Through 52 hospitals and more than 1,000 access points including flagship academic medical centers in Dallas and Temple, the system offers the full continuum of care, from primary to award-winning specialty care, throughout Texas, and via virtual touchpoints. If its service area were a state, it would be the eighth largest, providing care to a population larger than that of the state of Georgia. Founded as a Christian ministry of healing, Baylor Scott & White is proud to honor its century-long legacy through its commitment to improving accessibility, affordability and the customer experience for all. For more information, visit