Nearly one-third of 'Pioneer' ACOs may opt out

Some of the organizations may join Shared Savings Program instead

Nine of the 32 "Pioneer" accountable care organizations (ACOs) may soon exit the program, which is one of the Affordable Care Act's signature initiatives to pilot better care at lower cost, Alex Wayne reports at Bloomberg Businessweek.

>> Also see: Tom Cassels explains why some Pioneers are dropping out 

Long-simmering concerns

Under the Pioneer program, which launched in January 2012, participating providers contracted with CMS to meet quality targets and assume new risk when caring for a set population of Medicare beneficiaries; in exchange, they received additional financial incentives.  

However, most of the Pioneer ACOs threatened in March to drop out of the program unless CMS updated its measures for performance and pay. While CMS eventually agreed to make some changes to data tracking and dissemination, it reiterated that it would begin linking the Pioneers' incentives to their quality performance this year, rejecting the program participants' request to delay.

At least four of the organizations that are opting out of Pioneer instead may join the Medicare Shared Savings Program, which offers less risk, according to a CMS spokesperson.

The decision by some organizations to leave the program is a "potential threat to the Affordable Care Act’s ambitious cost-saving goals," Wayne writes. Specifically, providers' willingness to opt out of the Pioneer program could "really sho[w] a critical cost-containment approach in the Affordable Care Act is running into real problems," according to Robert Blendon, a health-policy professor at Harvard University’s School of Public Health.

Blendon suggested that participants may be learning that the added risk of managing care for chronically ill patients is more difficult than they anticipated (Evans, Modern Healthcare, 6/28 [subscription required]; Wayne, Bloomberg Businessweek, 6/28).


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