Pioneer ACOs: Anatomy Of A ‘Victory’

On May 4, 2015 Department of Health and Human Services (HHS) Secretary Burwell announced that the Pioneer ACO program had saved the federal government $384 million and improved quality in its first two years and would therefore be expanded. HHS also released a 130 page independent program evaluation by L&M Policy Research that served as the basis for the Centers for Medicare and Medicaid Services (CMS) Actuary’s certification of the Pioneer program. Burwell’s triumphant announcement was an intended shot in the arm for the troubled Pioneer ACO program, 40 percent of whose initial 32 members dropped out in the first two years. It also illustrated the yawning reality gap between DC policymakers and the provider-based managed care community. In reality, the Pioneer program badly damaged CMS’s credibility with the provider-based managed care community and sharply reduced the likelihood that the ACO will be broadly adopted. If the Secretary’s goal of having 50 percent of regular Medicare’s payments come through “Alternative Payment Methodologies” by 2018 is to be met, that growth is unlikely to come from either the Pioneers or the larger Medicare Shared Savings Program (MSSP). Table I below shows why. A Flawed System Rewarded Those In High-Spending Areas, Not Good Performers As with the Physician Group Practice (PGP) Demonstration that preceded the Pioneers, savings among the Pioneers are highly concentrated in a fraction of the participants. According to the L&am...
Source: Health Affairs Blog - Category: Health Management Authors: Tags: Costs and Spending Featured Following the ACA Medicare Organization and Delivery Payment Policy ACO Medicare Shared Savings Program Patrick Conway Physician Group Practice Demonstration Pioneer ACOs Secretary Burwell Source Type: blogs