Dive Brief:
- CMS has published quality and financial performance for individual participants in its Pioneer ACO program for the first time, reporting mixed results when it came to savings. Participants are a small, select group of providers chosen for Medicare's most ambitious test of the possibilities of the ACO model.
- The first year financial results showed that health spending fell as much a 7% among some ACOs, while rising as much as 5% for others. During the second year, healthcare spending dropped as much as 5.4% among those that reduced patients' medical bills but shot up as much as 5.6% when costs escalated.
- Given the escalation of costs for some ACOs, several have dropped out of the program. Eight of the nine ACO's to leave the program in the first year reported a growth in health spending. The ACO that reported this largest growth in health spending, Plus North Texas ACO, left the program entirely when costs grew 5.2% faster than it had projected.
Dive Insight:
Regardless of how CMS positions the data it has, it seems clear that the Pioneer ACO program has serious problems. Participants have continued to drop out of the Pioneer effort—most recently Franciscan Alliance, Genesys PHO and Renaissance Health Network—generally because the program didn't seem likely to net them any money, and in some cases might have forced them to give money back to Medicare. CMS doesn't seem to have a handle on what the Pioneer ACOs need, some ex-participants say.
On the other hand, providers have done better with the Shared Savings Program, with Medicare adding 340 ACOs to this version of the program. This model poses fewer risks to providers while offering the possibility for some gains if they meet financial and quality standards. The Shared Savings Program imposes 33 quality measures, including admissions for heart failure, admissions for chronic obstructive pulmonary disease or asthma and older adults and general readmission measures, but these measures are already becoming standard in many commercial payer models, so making the effort to meet them makes sense. Perhaps the Pioneer program will fall apart, but the Shared Savings Program seems like it may be a winner.
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