Pioneer ACOs: The Frontier of Delivery System Reform?
June 13, 2014
The Patient Protection and Affordable Care Act (ACA) of 2010 introduced accountable care organizations (ACOs) to Medicare with the goals of reducing costs, improving care to beneficiaries, and moving from fee-for-service to population-based payment for health care. Proponents of the ACO model believe that reducing unnecessary services, preventing avoidable hospital admissions and readmissions, and coordinating care would generate savings that could be shared between the Medicare program and ACOs. Two variants of the ACO model account for the vast majority of ACOs: the Pioneer ACO program and the Medicare Shared Savings Program (MSSP). The Center for Medicare & Medicaid Innovation initiated the Pioneer ACO model demonstration specifically for organizations with experience offering coordinated, patient-centered care. The MSSP, made a permanent part of the Medicare program by the ACA, was designed to encourage the development of ACOs. ACOs participating in both programs who meet quality and spending benchmarks are able to share in savings (as well as losses), although the Pioneer program features higher levels of rewards and risks than the MSSP. Of 32 organizations participating in the Pioneer ACO program in the first year, about 40 percent received a share of savings, whereas two organizations exceeding their spending targets had to return money to Medicare. After the first year, seven Pioneers chose to move to the MSSP, and two left the ACO program altogether. This Forum session explored the experiences of two Pioneer ACOs and drew lessons for the future of delivery system and payment reform.
With Comments From:
Hoangmai Pham, MD, MPH (bio)
Director, Seamless Care Models Group
Center for Medicare and Medicaid Innovation
Centers for Medicare & Medicaid Services