Feds seek pi­o­neer­ing ACOs

Pi­o­neer model to kick-start ACOs

Modern Healthcare - - Front Page - Jessica Zig­mond

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

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