Toward Accountable Payment

The results are in: How did the Pioneer ACOs do?

by Rob Lazerow

Last week, CMS released performance results for the first year of the Pioneer ACO Model, which offered the first pulse check on the Affordable Care Act’s high-profile ACOs.

Designed for organizations with experience managing population health, the Pioneer ACO Model has a higher-risk, higher-reward structure than the larger Medicare Shared Savings Program (MSSP). For a full description of Pioneer—and how it differs from MSSP—read our white paper.

Overall positive financial and quality results

For the first year of the Pioneer ACO Model, more then 669,000 Medicare fee-for-service beneficiaries were attributed to the 32 Pioneer ACOs. The financial results were generally positive, but inconsistent, across the ACOs. Highlights of the 2012 financial results include:

  • Cost savings: The Pioneer ACOs generated $87.6 million in gross savings across 2012.
  • Cost growth reduction: Costs for beneficiaries treated by Pioneers grew by 0.3% in 2012, whereas costs for similar beneficiaries outside of Pioneer grew by 0.8%. As I commented to Family Practice News, this represents early evidence of ACOs bending the cost curve.
  • Shared savings payments: 13 Pioneers qualified for shared savings bonuses totaling $76 million; 2 Pioneers qualified for shared savings losses of approximately $4 million. As a comparison, only 2 of 10 participants in Medicare’s Physician Group Practice Demonstration—the precursor to both Pioneer and the MSSP—qualified for bonuses in their first performance year.

While the financial results were inconsistent, with roughly 40% of participants qualifying for shared savings bonuses, the quality results were more uniformly positive. Highlights include:

  • Quality reporting: All 32 ACOs successfully reported the quality measures required by the program. Given the new metrics included, quality reporting has been a concern from the outset.
  • Clinical quality: For the 15 quality metrics with available comparison data, Pioneer ACOs outscored the published rates for all of fee-for-service Medicare.
  • Readmission rates: 25 of the Pioneers demonstrated successful readmission reduction, outperforming the benchmark for all Medicare beneficiaries.

Some ACOs leaving Pioneer

You may have heard that nine of the 32 Pioneer ACOs have decided to leave the Pioneer ACO Model. Seven of the Pioneers will shift to the MSSP, and two will exit from the Medicare ACO programs entirely. For full analysis, read my colleague Tom Cassels' interview with the Daily Briefing.

Inside Medicare's ACO programs

To succeed under delegated risk models, providers must have "all of their business—or close" at risk. See how AtlantiCare, Montefiore Care Management, and Coastal Medical Group are doing just that.


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