Taking a closer look at the Pioneer ACO first-year report card
One would think, given the title of the CMS press release, “Pioneer Accountable Care Organizations succeed in improving care, lowering costs,” that the first year of the advanced ACO program was an across-the-board roaring success. But upon closer examination, the report card would appear to be rather checkered.
While it’s certainly true that 13 of the 32 Pioneers succeeded in the first year, generating some shared savings, seven of the ACOs have opted to step down to the less-risky Medicare Shared Savings Program (MSSP) and two have decided to no longer be a Medicare ACO, Pioneer or MSSP. That leaves 10 Pioneers that are still in the Pioneer program, but did not have a successful first year. I'm sure that the providers in those ACOs are adopting a "wait and see" attitude regarding the viability of the model and whether it rewards them sufficiently for their efforts.
The mixed results are not a surprise, given the Feb. 25, 2013 letter from 30 of the 32 Pioneers to CMS that expressed concern about the program’s quality benchmarks and lack of data and requested reporting-based, as opposed to performance-based, payments for performance year 2013. All nine of the Pioneers that are either transitioning to the MSSP or are ceasing to be Medicare ACOs signed that letter.
These results are reminiscent of what happened with the Physician Group Practice (PGP) Demonstration Project, a precursor to the current Medicare ACO programs, in which only two of 10 participating ACOs succeeded in the first year. Encouragingly, the participants in the PGP Demonstration Project in general improved their performance during the following years, so one would expect the 23 Pioneers still in the program to show better results in the years ahead.
That being said, that fact that only a minority of the Pioneers succeeded in year one will probably deter some organizations from applying to the Pioneer program in the future. For the 10 Pioneers that did not succeed in the first year but are still in the program, this coming year will be the make-or-break year for them, since shared savings provide the economic engine to reward providers and sustain the ACO model.
It should be noted that IPAs, networks and newly formed partnerships account for six of the nine departing Pioneers. These entities are generally less tightly integrated than integrated delivery networks, and they evidently had some difficulties getting organized and pulling together the requisite coordinating infrastructure, analytics and processes to function effectively in their first year as an ACO.
Interestingly, geographically, not a single one of the nine departing Pioneers are in the Northeast, even though almost a third of the 32 Pioneers are in that region.
