$29.7M in annual savings and counting: 5 questions with Millennium ACO's CEO Kevin Kearns

Fort Myers, Fla.-based Millennium ACO netted $29.7 million during the 2017 Medicare Shared Savings Program year, making it the best-performing ACO in terms of shared savings that year.

Collectively, MSSP ACOs generated $314 million in net savings to Medicare in 2017, when incorporating bonuses paid to the ACOs, according to MSSP performance data released by CMS Aug. 30. Kevin Kearns, CEO of Millennium, told Becker's he thinks the ACO's characteristics as an independent, primary care physician-led organization are paramount.

"This has been our fifth year in the program, and we've learned something new every year," Mr. Kearns, who stepped into the CEO position three years ago, said. "I think it's important that we are a primary care physician-based organization. We're an independent group. We're not affiliated with a hospital or a plan or other entities."

Mr. Kearns, a Fort Myers native and a graduate of Williamsburg, Va.-based William & Mary and an MBA recipient at the University of South Florida in Tampa, answered five questions in an interview with Becker's. He discussed Millennium's 2017 performance year, why he believes unaffiliated ACOs produce the best results, and what the ACO of the future may be.

1. Question: Millennium ACO was the best-performing MSSP ACO in 2017, with $29.7 million in shared savings. How'd you do it?

Kevin Kearns: It starts with our physicians, our advanced providers, and their engagement. They see the ACO as their opportunity to make a difference in their patients' healthcare. And they take it to heart. There's a lot of pride in the physicians at Millennium. They want to know they're doing everything they can to improve patient care.

2. Q: Millennium has been in the ACO game since 2013. What has changed in the past five years? What have you learned in the past three at the helm?

KK: When MSSP was launched in 2013, not only was it new to us, it was new to everyone in the country. There was a lot of trepidation going into the ACO program. When we got the results back for year one, two and three, we kept seeing improvement. All of a sudden, our ACO program became not just a project on the side, but an integral part of what we do.

That being said, it's a big gamble — a financial and infrastructure gamble — all in the spirit of improving patient care. But now that we've had several years under our belt, we know that it pays off. Honestly, the biggest challenge is directing the transition of care from the hospital, whether it's to a home or skilled-nursing facility, or primary care visits to avoid the unnecessary readmissions. The second biggest challenge is patient education about when is it appropriate to use the emergency room. For us, that's been a big opportunity and a big learning curve.

3. Q: What makes a physician-based ACO different than system-led or payer-led ACOs, in your opinion?

KK: I believe not being part of a system and a plan with expectations about where referrals go, and instead being able to make sure the patient goes to the best place for care at the right time, makes a huge difference. We certainly work with preferred providers we know are going to give the highest quality of care. Because we don't have any kind of constraints on where the patients are going, our physicians can make the best decision.

4. Q: Millennium's primary care physicians managed care for 250,000 patients in Southwest Florida. What is the biggest challenge those physicians face? How do you address this from the top down?

KK: We have a tremendous physician leadership structure within the organization led by regional medical directors. We meet on a monthly basis with all of the physicians and advanced providers, so they have a venue to discuss any issues concerning leadership. We do regular roundings with physicians. We'd rather not wait for them to call us. We'd rather be proactive and see what concerns they're facing, particularly in value-based care, where the rules of the game have changed over the last several years.

Q: What is the ACO of the future?

I love that question. I look at it as not necessarily the ACO of the future, but what is the health delivery system of the future. I'm not sure what's going to change for ACOs or the Medicare Advantage plans. What we focus on at Millennium is making sure we take the best care of the patients — "every patient, every time." That's our saying. If we do that and we do it well, we'll continue to be successful.

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