Cedar Gate's AI-Powered Models that Predict CAD & CHF Risk Could Save $1.4 Billion+ READ PRESS RELEASE >

Integrated Delivery System Sees $44 Million ACO Performance Improvement with Cedar Gate Consulting

generic -healthcare logo-small-long


Making the Most of Analytics Data for ACO Success

When one of the largest Catholic healthcare systems in the Midwest embarked on its value-based care journey as a Centers for Medicare and Medicaid (CMS) Pioneer Accountable Care Organization (ACO) and then in the Medicare Shared Savings Program (MSSP), it was a challenge. In 2016, they missed the CMS benchmark for PMPM spending by almost $30 million, and missed the target for financial savings by $41.6 million.

The following year they got closer, but still didn’t achieve enough to share in the savings. The organization was using Cedar Gate’s Value-Based Care Analytics software, but had not been able to make use of the data in meaningful ways to impact their ACO success.

Specifically, the Catholic healthcare system wanted to:

  • Gain more experience with downside risk
  • Create a blueprint for success in all their risk-based contracts
  • Increase participation in full risk-based models for greater reward potential
  • Expand market share with bundled payments and direct employer relationships

Engaging with Our Experts to Improve Performance

They lacked the internal expertise to analyze their current roster of MSSP beneficiaries due to high levels of churn, and high out-of-network utilization rates among assigned beneficiaries. They also didn’t know how to identify primary care provider (PCP) participants with whom to partner on risk-based models, or how to design and engage in prospective bundles.

The organization engaged Cedar Gate to perform actuarial consulting services, and saw significant improvement in multiple areas of MSSP performance.

Actuarial Insights & Analytics Software Help Achieve VBC Goals

Cedar Gate’s actuarial insights, combined with its Value-Based Care Analytics software, helped them:

Capture Millions from In-Network Care

By identifying out-of-network leakage, and steering more patients to in-network providers to reduce out-of-network utilization, the organization brought back millions in revenue. Providing more in-network care also helped the organization meet its value-based care goals as an ACO.

Establish Prospective Bundles Contracts

The healthcare system contracted with multiple large, self-insured employers to create orthopedic and imaging prospective bundled agreements. These bundles create more stable and predictable costs for some of the most common surgical and imaging procedures.

Predict Risk-Based Contract Performance

With predictive models in Cedar Gate’s Value-Based Care Analytics Software, the Catholic healthcare system was able to predict performance in risk-based contracts with 99.4% success rate when compared to actual results, giving them confidence to participate in these models.


$44 Million Turnaround in Two Years

Within two years, the healthcare system went from missing the CMS benchmark by $29.9 million to exceeding it by $14.4 million, a $44 million turnaround. They achieved a total of $18.6 million in shared savings over three years. Cedar Gate’s actuarial consulting services also helped them:

  • Increase revenue $28 million by recapturing network leakage in colonoscopy, orthopedic, and cardiovascular service lines, and post-acute care
  • Achieve $25 million performance improvement by sculpting a high-performance network of PCPs, specialty physicians, and post-acute and ancillary care facilities
  • Create a “Home Health First” program to redirect medically appropriate patients to home health agencies instead of skilled nursing facilities, reducing costs by $1 million annually
  • Update billing practices and build a PCP network for its assigned beneficiaries, resulting in a $57.4 million turnaround in total cost of care
  • Negotiate full-risk Medicare Advantage (MA) agreements with four payers, leading to $4.9 million in additional shared savings in subsequent years


Discover how our clients use our solutions to succeed in value-based care. 

Explore the Platform

The right solution for your value-based journey is only a click away. Our modular technology is quickly and easily integrated into current systems and complements existing IT investments so that we can grow with you.

Your browser is out-of-date!

Update your browser to view this website correctly. Outdated Browser