Re­struc­ture ACO model so it’s less puni­tive, more flex­i­ble

Modern Healthcare - - COMMENT -

The re­cent ar­ti­cle “Two more Pioneer ACOs exit as new CMS model emerges” (Mod­ern­Health­, Nov. 4) raises good ques­tions about why half of the orig­i­nal 32 Pioneer ac­count­able care or­ga­ni­za­tions have dropped out of the pro­gram. Ar­guably the high­est-qual­ity and low­est-cost Pioneer based on 2014 CMS data, Bellin-ThedaCare Health­care Part­ners, strug­gles with many of the same is­sues.

We, along with some of our col­leagues, have stud­ied and writ­ten ex­ten­sively about why the Pioneer ACO pro­gram isn’t work­ing, and how it could be re­struc­tured. As noted in the ar­ti­cle, fu­ture sav­ings are not only more dif­fi­cult to achieve, but fi­nan­cially puni­tive for or­ga­ni­za­tions that are al­ready ex­tremely ef­fec­tive at de­liv­er­ing high-value care to pa­tients.

Some of the ad­just­ments we sug­gest, based on years of ex­pe­ri­ence in the pro­gram, in­clude: risk-, ge­o­graphic- and out­comes- ad­justed pay­ments; pa­tient at­tri­bu­tion that is also flex­i­ble to al­low for pa­tient mo­bil­ity; and aligned pa­tient ben­e­fits. For more de­tail on how the next gen­er­a­tion ACO pro­gram could be re­struc­tured, read our blog post at

We are hope­ful and en­cour­aged that the CMS is open to ex­plor­ing what “bet­ter” looks like ac­cord­ing to those clos­est to the work. Dr. John Tous­saint

CEO ThedaCare Cen­ter for Health­care Value

Ap­ple­ton, Wis. Dr. David Krueger Ex­ec­u­tive di­rec­tor Bellin-ThedaCare Health­care Part­ners

Green Bay, Wis.

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