- The Centers for Medicare and Medicaid Services announced on Monday that the controversial Pioneer ACO program has saved $384 million over the past two years, enough to justify a program expansion.
- The agency had not anticipated making a decision on the viability of the program until the end of its initial five-year run, according to CMS' chief medical officer, Dr. Patrick Conway. "We thought it might take that long to generate results," Conway said. Instead, CMS is "excited" to have "such robust results… after only two years of evaluation."
- The program saved over $300 per year for each of the 600,000 beneficiaries, according to CMS.
For some, the Pioneer program wasn't a slam-dunk. Out of the original 32 participants, 13 either dropped out or switched the Medicare Shared Savings Program, primarily due to high costs. Two ACOs had to pay back millions to CMS for failing to meet program benchmarks.
There were also significant payment fluctuations over time, notably a drop-off from $279.7 million in 2012 to $104.5 million in 2013. Conway said CMS is "looking into it," according to Health Leaders Media, but offered no explanation, instead suggesting waiting until third-year results are analyzed.
According to Conway, criticisms of the program have been addressed in the new MSSP model, Track 3, which is not yet finalized but will offer two-sided risk.
"We're actually embedding the design elements from the Pioneer ACO model into the Medicare Shared Saving Program, specifically the proposed Track 3," Conway said.
Premier Inc. released a series of suggested improvements to the program on Monday, including: using a risk-adjustment methodology that accounts for individual beneficiaries' acuity; a "more appropriate balance" between risk and reward, including higher shared savings for high-quality providers and "a period where risk can be phased in over time"; and allowing beneficiaries to attest to participation in ACOs.
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