Feds seek pioneering ACOs
Pioneer model to kick-start ACOs
After its 429-page set of proposed accountable care organization regulations landed with a thud in the industry, the CMS may renew provider interest in ACOs with three new initiatives. Chief among those is a plan to get ready-made ACOs into the Medicare program fast and encourage other providers to follow later.
Dr. Thomas Graf, associate chief medical officer for population health at Geisinger Health System in Danville, Pa., said the new initiatives reflect the CMS’ openness to working with provider groups. That is in “stark contrast to the ACO regs, which were restrictive and prescriptive,” Graf said.
The quick-start plan is called the Pioneer ACO Model, which will be administered by the Center for Medicare and Medicaid Innovation starting this summer. In a fact sheet about the new Pioneer model, the Innovation Center said it is designed to let provider groups move more quickly from a shared-savings payment model to a population-based model on a track that is both consistent with—but separate from—the Medicare Shared Savings Program. A CMS spokeswoman said the Medicare Shared Savings Program refers to what the CMS establishes under the final ACO regulation. Also, the CMS said the model is intended to coordinate with private payers.
Providers interested in the Pioneer ACO track will have to work quickly. They must submit a letter of intent to the CMS by June 10, and applications are due by July 18.
The CMS said it expects about 30 Pioneer ACOs, which it said could save Medicare about $430 million over a three-year period.
“They’re really serious about people who are ready to take risk at scale,” said Terry Carroll, senior vice president of transformation and chief information officer at Fairview Health Services in Minneapolis. “We’ll seriously consider doing it because of the work we’ve done in the commercial space.”
Carroll said Fairview spent the latter part of 2008 and early 2009 changing the way it delivered care. The seven-hospital system approached commercial payers—Medica, Blue Cross and Blue Shield of Minnesota, HealthPartners and Preferred One—to evolve the model, which included what Carroll called innovation clinics—or primary-care clinics that developed team-based care. Today, all 42 of its clinics are certified as health homes through the state’s certification process. And about 53% of Fairview’s total revenue—which is about $2.6 billion—comes from the payment structures between Fairview and those commercial plans, a system spokesman said.
In its second of three ACO initiatives