The first-year report card for the Medicare Pioneer Accountable Care Organizations (ACOs) shows that more plans saved money than lost, but also that some providers have decided to either exit the program or take a step back and move to the less risky traditional shared-savings model.
The Pioneer ACO model was designed for more advanced, higher-performing organizations. The 32 provider groups that signed up to be Pioneers agreed to generate more savings than traditional shared-savings ACOs. Some of the Pioneers also agreed to take on more risk. The upside was if they met their savings and care benchmarks, these providers would get a larger return on that effort. (“Pioneer Accountable Care Organization First-Year Results Include Savings and Losses,” Washington Health Policy Week in Review, Congressional Quarterly HealthBeat, July 16, 2013)
The Centers for Medicare and Medicaid Services (CMS) report noted that all 32 Pioneer participants did well on reported quality measures and earned incentive payments for their quality achievements. The Pioneer ACOs exceeded provider performance in traditional fee-for-service Medicare for all 15 quality measures in which comparable data are available, the agency said. (“CMS Names ACOs Leaving Pioneer Program,” Modern Healthcare.com, July 16, 2013)
Additional results noted in the report were as follows:
- Of the 32 Pioneers, 18 had savings and 14 generated losses in 2012.
- Of the 18 that saved money, 13 had a high-enough savings margin that they will get money from Medicare. They had a gross savings of $87.6 million, resulting in about $33 million savings for Medicare. Together, those ACOs shared in more than $76 million as a result of their coordination of care.
- Of the 14 that generated losses, two plans that had agreed to take on more risk had high-enough losses that they will owe Medicare money.
- For the more than 669,000 Medicare beneficiaries who belong to Pioneer ACOs, costs to treat them grew by 0.3 percent in 2012, compared to costs for similar beneficiaries outside the ACO model, which grew by 0.8 percent.
CMS attributed part of the savings to reduced hospitals admissions and readmissions. (“Pioneer Accountable Care Organization First-Year Results Include Savings and Losses,” Washington Health Policy Week in Review, Congressional Quarterly HealthBeat, July 16, 2013)
CMS said that Primecare Medical Network, University of Michigan, Physician Health Partners, Seton Health Alliance, Plus (North Texas Specialty Physicians and Texas Health Resources), HealthCare Partners Nevada ACO, HealthCare Partners California ACO, JSA Care Partners and Presbyterian Healthcare Services will not continue in the second year of the Pioneer program. (Plus and Presbyterian do not intend to transition into the Medicare Shared Savings Program, according to Modern Healthcare staff interviews with their executives.)
Despite the news that nine Pioneers won’t continue in the program for year two, CMS emphasized the improved quality that Pioneer ACOs provided in the first performance year. For example:
- 25 of the 32 participants generated lower risk-adjusted hospital readmission rates for their beneficiaries against the benchmark rate for all Medicare fee-for-service beneficiaries
- Better performance on clinical quality measures that assess low-density lipoprotein (LDL) control for diabetic patients.
(“CMS Names ACOs Leaving Pioneer Program,” Modern Healthcare.com, July 16, 2013)
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