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October 9, 2014

First look: How the Pioneer ACO near you has performed

Daily Briefing

    CMS for the first time has released quality and financial data for individual Pioneer ACOs, a select group of organizations that agreed to participate in the most ambitious test of the ACO model to date.  

    The results come three year after the program first launched, much later than many observers had hoped, according to Modern Healthcare.

    Background on the Pioneer ACO program

    Under the Pioneer program, which launched in January 2012 with 32 organizations, participating providers contract with CMS to meet quality targets and assume new risk when caring for a set population of Medicare beneficiaries; in exchange, they receive additional financial incentives.

    However, 13 of the original participants have dropped out of the program:

    • Last year, seven Pioneer ACOs that did not produce savings in the first year of the Pioneer program switched to the Medicare Shared Savings Program (MSSP), and two abandoned Medicare accountable care models altogether.
    • In August, another ACO dropped out of the Pioneer program.
    • In September, three more ACOS dropped out, and two of those ACOs said they would more to MSSP.

    Infographic: How ACOs fit into broader payment innovation efforts

    The Pioneer results

    The data set includes the financial performance data for all Pioneer ACOs in the program's first two years.

    The first-year results included the performance of all 32 original Pioneer ACOs. Organizations that performed better than their benchmark and above the minimum savings rate shared some of the savings, while those that increased spending beyond their benchmark and their minimum loss rate helped cover the additional costs.

    According to the report, health spending during the first year slowed by about 7% as a percentage of the organization's benchmark among some ACOs, while it increased by up to 5% for others. The ACOs that slowed spending the most in 2012 include:

    • New York City-based Montefiore ACO, which slowed spending by 7.1%, for which it received $14 million;
    • California-based Monarch HealthCare, which slowed spending by 6.3%, for which it received $6.07 million;
    • Indiana-based Franciscan Alliance, which slowed spending by 6%, for which it received $6.67 million; and
    • Northern California-based Brown & Toland Physicians, which slowed spending by 6%, for which it received $5.34 million.

    "The acid test for me is not whether the ACO program survives."

    The 2013 results, which include the performance of 20 ACOs, show that some Pioneer ACOs slowed spending by 5.4%, while others increased spending by up to 5.6%.

    In 2013, Montefiore and Monarch again slowed spending relative to the organizations' benchmarks by the largest percentages—by 7% and 5.4%, respectively. The next largest savings percentages included:

    • Michigan Pioneer ACO, which slowed spending by 4.9%, for which it received $5.95 million; and
    • Beth Israel Deaconess Care Organization, which slowed spending by 3.9%, for which it received $10.6 million.

    The data set also included site-specific performance on 33 quality measures in the first and second year of the program (Evans, Modern Healthcare, 10/8 [subscription required]; Pioneer ACO financial results, October 2014).

    Expert take: Why one ACO dropped out

    Hamza Hasan, Health Care Advisory Board

    When we've spoken with leaders of Pioneer ACOs, we've heard that patient churn and the network leakage issue is something they have really struggled with. And as it relates to choosing between the Medicare Shared Savings Program (MSSP) and Medicare Advantage (MA), they have found that patient churn and network leakage tends to be a lot lower in MA than MSSP.

    We see Sharp, and other care management pioneers, more likely to focus on risk contracts that will give them a greater ability to negotiate benefit design and patient attribution than in MSSP.

    For the rest of Hamza's comments click here.

    Learn From Experienced ACOs

    Watch leaders from three leading Medicare ACOs—AtlantiCare, Montefiore Medicare Center, and Costal Medical Group—discuss their experiences.


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