Banner, Montefiore, Partners see big savings in Pioneer ACO program, while others overspend

Montefiore Medical Center

Two Pioneer Accountable Care Organizations, Montefiore Health and the Banner Health Network, on Tuesday touted their success in generating savings for the Centers for Medicare and Medicaid Services ACO model. Though other organizations in the group found little reason to celebrate.

CMS released 2014 performance data on its Pioneer and Medicare Shared Savings Program ACOs on Tuesday.

According to New York-based Montefiore, the ACO generated 3.6 percent in gross savings and earned an overall quality score of 86.21 percent, a 10 percent jump compared to the prior year.

Montefiore said it treats more than 28,000 people through its ACO.

[Also: Shared savings ACOs earn $341 million in payments 2014]

CMS said Pioneer ACOs generated more than $120 million in savings in 2014, while the mean quality score jumped to 87.2 percent compared to 85.2 percent in 2013.

CMS also said 15 out of the 20 participating ACOs generated savings, and 11 of those will receive payments, including Montefiore, which scored $8.4 million.

The Pioneer ACO program is a risk-based model designed for more advanced healthcare providers. If an ACO generates savings above its benchmark then CMS pays them back a portion of those savings. On the other hand, organizations that spend above benchmark may pay penalties to CMS. In 2014, three Pioneer ACOs fell into that category, and will pay back CMS $9 million in total.

[Also: Dartmouth-Hitchcock ACO excels on pioneer attitude towards payments]

The program has also seen its share of dropouts. While the model launched with 32 organizations, all but 19 dropped out.

On the other hand, Phoenix-based Banner Health, which covers 61,000 beneficiaries, recorded the best financial results of the Pioneer ACO group. The organization saved Medicare more than $29 million and will net an $18 million payout from CMS. The ACO's overall quality score was 87.5 percent.

"Banner Health, BHN, and our physician partners have made significant investments in accountable care because we believe it is vital to the sustainability of healthcare in this country," said CEO Lisa Stevens Anderson in a statement. "We have taken bold steps to transform our organization in support of value-based care, and we are beginning to see the results of those actions."

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Banner has also expanded its ACO model to include major commercial insurers like Aetna, Cigna and Blue Cross Blue Shield of Arizona.

Massachusetts-based Partners HealthCare also saw huge success in the program. That ACO saved Medicare nearly $22 million and will receive $13 million in a shared savings payment.

While CMS said five ACOs spent above benchmark, only three of those spent enough to trigger penalties. Maine-based Beacon Health, which had one of the highest quality scores in the group, will pay back nearly $3 million. New Hampshire-based Dartmouth-Hitchcock will pay back nearly $4 million and Indianapolis-based Franciscan Alliance ACO, which left the program in September 2014, will pay $2.5 million.

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