Exit strat­egy

Up to nine Pi­o­neer ACOS may leave pro­gram

Modern Healthcare - - LATE NEWS - Me­lanie Evans

Medi­care’s most am­bi­tious test of ac­count­able care could lose a sub­stan­tial num­ber of its par­tic­i­pants af­ter the first year. As many as nine of 32 Pi­o­neer ac­count­able care or­ga­ni­za­tions—the name given to Medi­care’s first and high­est-risk test of the pay­ment model—may exit the pro­gram, ac­cord­ing to the CMS, and at least four have started to no­tify providers. At least four of the de­part­ing ACOs ten­ta­tively say they will join Medi­care’s lower-risk ACO al­ter­na­tive, the Shared Sav­ings Pro­gram, the CMS said. Pi­o­neers must de­cide by July 31. “We’re en­cour­aged that th­ese or­ga­ni­za­tions want to con­tinue in pro­grams that pro­mote bet­ter care at lower costs,” said CMS spokesman Alper Oz­i­nal. “We fully an­tic­i­pated that as th­ese pro­grams get up and run­ning, some or­ga­ni­za­tions would shift be­tween mod­els.”

Medi­care launched the Pi­o­neer ACOs in Jan­uary 2012 un­der the Cen­ter for Medi­care and Med­i­caid In­no­va­tion, which was cre­ated by the Pa­tient Pro­tec­tion and Af­ford­able Care Act.

Pi­o­neers en­tered into con­tracts that re­quired hos­pi­tals and doc­tors to achieve sav­ings on pa­tients’ med­i­cal costs and meet qual­ity tar­gets in or­der to re­ceive fi­nan­cial in­cen­tives. ACOs stood to earn bonuses in the first year, and some agreed to more high-stakes deals that in­cluded larger po­ten­tial re­wards and pos­si­ble losses.

Cost and qual­ity re­sults for the first year are not yet avail­able. Pi­o­neer con­tracts grow more ag­gres­sive each year. All Pi­o­neers risk pos­si­ble fi­nan­cial losses based on per­for­mance af­ter the sec­ond year, which be­gan last Jan­uary.

By con­trast, ACOs in Medi­care’s Shared Sav­ings Pro­gram may choose an op­tion with no po­ten­tial for fi­nan­cial penal­ties for the first three years. The pro­gram is larger, with 220 ACOs, and is ex­pected to ex­pand next year.

Whether all Pi­o­neer ACOs would con­tinue with the ini­tia­tive has been in doubt since Fe­bru­ary, when providers chal­lenged pro­posed bench­marks for qual­ity per­for­mance in the sec­ond year. The CMS agreed to re­vise the bench­marks, but ne­go­ti­a­tions be­tween Pi­o­neers and the CMS con­tin­ued and talks were not limited to the qual­ity de­bate.

Pres­by­te­rian Health­care Ser­vices, based in Al­bu­querque, has not yet de­cided whether to exit the Pi­o­neer pro­gram, said Kristen Krebs, a spokes­woman for the sys­tem.

In Mas­sachusetts, Atrius Health and Stew­ard Health Care Sys­tem will con­tinue as Pi­o­neers, rep­re­sen­ta­tives for those sys­tems said.

In Wis­con­sin, Bellin-ThedaCare Health­care Part­ners will re­main a Pi­o­neer, a spokes­woman con­firmed. ACOs op­er­ated by the Eastern Maine Health­care Sys­tem and the Her­itage Provider Net­work also will stay in the pro­gram, their rep­re­sen­ta­tives said.

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