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By Nathaniel Weixel
The Centers for Medicare & Medicaid Services Dec. 19 said it had selected 32 health care systems to participate in a “Pioneer” accountable care organization (ACO) initiative designed to better coordinate care across providers and lower costs.
The Pioneer ACO initiative, which will be funded through the Patient Protection and Affordable Care Act, will encourage primary care doctors, specialists, hospitals, and other caregivers to provide better, more coordinated care for people with Medicare and could save up to $1.1 billion over five years, CMS said.
All ACOs, including the ones named Dec. 19, will be eligible to receive shared savings if they demonstrate they have reduced costs and improved their patients' quality of care.
The Pioneer model was designed specifically for organizations with experience offering coordinated, patient-centered care and operating in ACO-like arrangements, CMS said. It allows organizations a similar but separate path to forming ACOs than the Medicare Shared Savings Program (MSSP).
CMS released the final MSSP rule (76 Fed. Reg. 67802) establishing ACOs in October (204 HCDR, 10/21/11).
Pioneer ACOs are different from other ACOs in that they can reap a greater share of savings than traditional ACOs under the MSSP, although they also must take on more risk.
CMS will publicly report the performance of Pioneer ACOs on quality metrics, including patient experience ratings, on its website. The first performance period will begin on Jan. 1, 2012, CMS said.
“Pioneer ACOs are leaders in our work to provide better care and reduce health care costs,” Health and Human Services Secretary Kathleen Sebelius said in a statement. “We are excited that so many innovative systems are participating in this exciting initiative—and there are many other ways that health care providers can get involved and help improve care for patients.”
According to CMS, the 32 Pioneer ACOs underwent a rigorous competitive selection process by the Center for Medicare and Medicaid Innovation (CMMI), including extensive review of applications and in-person interviews. CMMI Director Richard Gilfillan said CMS chose from a pool of 80 applicants.
Gilfillan said the selected participants include physician-led organizations and health systems, urban and rural organizations, and organizations in various geographic regions of the country, representing 18 states and the opportunity to improve care for about 860,000 Medicare beneficiaries.
The participants included organizations such as:
• Allina Hospitals & Clinics in Minnesota;
• Banner Health Network in Arizona;
• Beth Israel Deaconess Physician Organization in Massachusetts;
• Dartmouth-Hitchcock ACO in New Hampshire and Vermont;
• Brown & Toland Physicians in San Francisco; and
• Monarch Healthcare in Orange County, Calif.
The Pioneer initiative will test the effectiveness of several innovative payment models and how they can help experienced organizations to provide better care for beneficiaries, work in coordination with private payers, and reduce Medicare cost growth, CMS said.
Pioneer ACOs are eligible for a greater share of savings than traditional ACOs under the MSSP, although they also take on more risk during the first two years of the program, CMS said.
In year three of the program, participating ACOs that have shown a specified level of savings over the first two years will be eligible to move a substantial portion of their payments to a population-based model. These models of payments will also be flexible to accommodate the specific organizational and market conditions in which Pioneer ACOs work.
The Premier healthcare alliance in a statement congratulated a number of its member organizations that were selected to participate in the Pioneer ACO program.
“These organizations are true leaders fostering the movement toward team-based, coordinated care,” Premier's Blair Childs, senior vice president of public affairs, said in a statement. “This alternative to the Medicare shared savings program will provide an advanced on-ramp to those systems who are well on their way to full continuum accountable care, while reinforcing the alternative payment arrangements they already have in place with private payors.”
Senate Finance Committee Chairman Max Baucus (D-Mont.) also praised the organizations chosen.
“These Pioneer Accountable Care Organizations will improve treatment and save money by making Medicare more nimble and responsive to our seniors' needs,” Baucus said in a statement. “And these organizations will pave the way to affordable, high-quality care throughout our healthcare system. Seniors are already saving money on better treatment thanks to health reform, and the efficient and coordinated care delivered by Pioneer ACOs will drive that progress even further.”
A description of the participants is at http://op.bna.com/hl.nsf/r?Open=nwel-8pprny . More information on the Pioneer program is at http://innovations.cms.gov/initiatives/aco/pioneer/ .
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