Pioneer ACO Model

On Monday, December 19, 2011 the Department of Health and Human Services announced 32 organizations that will take part in the Pioneer ACO model. As you can read in this article linked here (ModernHealthCare.com) there was a competitive selection process to see which organizations would participate in the project to be monitored by the CMS Innovation Center.

This model was started in January 2011 and is meant to show how particular ACO payment arrangements can best improve care and generate savings for Medicare. It also tests alternative program designs for future rules that are developed for the Medicare Shared Savings Program. Organizations that partake in this model should have experience operating as ACOs.

The first two years of the Pioneer ACO model are shared savings payment arrangements with higher levels of savings and risk than in the Shared Savings Program and other ACO initiatives. Year three, organizations showing a certain minimum of savings since starting the program will be able to transition away from a fee-for-service model to a population-based arrangement. Pioneer ACOs must negotiate outcomes-based arrangements with payers by the end of year two and are typically responsible for at least 15,000 beneficiaries.

The evolution of healthcare delivery could have an effect on MedSpan’s clients, no matter what segment of the healthcare system within which they function. Improving care while managing costs is a common goal among most businesses involved in healthcare, so staying informed on a potential process that will help accomplish this is of great interest to many.

The 32 organizations adopting Pioneer ACO structures will test various payment arrangements in aims of providing higher quality care at a lower cost. The project hopes to produce $1.1 billion in savings over five years and improve care for approximately 860,000 Medicare beneficiaries by ensuring that each healthcare dollar is spent more wisely. The goal is that patients, especially those that are chronically ill, receive the right care at the right time and unnecessary duplication of services is avoided.

The ideal result of the Pioneer model is to offer more coordinated, patient-centered care. Patients with multiple doctors will have an easier time communicating with each one. Pioneer ACOs aim to decrease the level of fragmented or disconnected care by providing better information to doctors about patients’ medical history and making it easy for them to communicate with their patients’ other doctors. Eventually this mindset will expand to all healthcare organizations, but changing the methods of delivery that have been practiced for so long will certainly not be easy.

Developing adjustments like this to the healthcare industry may bring forward new challenges for everyone. The near future will be an important time for these participants and their potential achievements with the model will affect other healthcare providers and consumers. If they succeed in providing higher quality care at lower costs, others will want to do the same. The results will be closely watched as changes are implemented. Although future success is uncertain, this program could lead to a significant shift in the industry which could hold increased benefits for all.

Primary care providers and other healthcare providers are the decision makers when it comes to participating in an ACO. Data manufacturers will benefit from this model because of the importance that patients and doctors place on the information available from ACOs.  But the organizational information must be well organized and easily accessible to all parties within a particular Pioneer ACO.  If the Pioneer ACOs model is successful, these organizations are likely to be well-accepted throughout the entire country.

Please share your thoughts.

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Author: Jamie Notaro

Editors: Robert Kaminsky & Ken Chiang

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