CMS Pioneer ACO
Program Location:
Baltimore, MD
Payer Type:
Grant
Reported Outcomes
Description:
[Ended December 31st, 2016] The Pioneer ACO Model (as authorized by Section 3021 of the Affordable Care Act) is designed specifically for organizations with experience offering coordinated, patient-centered care, and operating in ACO-like arrangements. It allows the selected provider groups to move more rapidly from a shared savings payment model to a population-based payment model on a track consistent with, but separate from, the Medicare Shared Services Program.
In addition, it is designed to work in coordination with private payers by aligning provider incentives, which will improve quality and health outcomes for patients across the ACO, and achieve cost savings for Medicare, employers and patients. The payment models being tested in the first two years of the Pioneer ACO Model are a shared savings payment policy with generally higher levels of shared savings and risk for Pioneer ACOs than levels currently proposed in the Medicare Shared Savings Program. In year three of the program, participating ACOs that have shown a specified level of savings over the first two years will be eligible to move a substantial portion of their payments to a population-based model. These models of payments will also be flexible to accommodate the specific organizational and market conditions in which Pioneer ACOs work.
Sharp HealthCare ACO exited the Pioneer program in August of 2014. In September, three more Pioneer ACO participants, Franciscan Alliance, Genesys PHO and Renaissance Health Network, exited the program. There are now 19 provider groups participating in the Pioneer ACO program.
Click here, for the report detailing the Effect of Pioneer ACOs on Medicare Spending in the First Year.
Related News & Resources
Payment Model:
In the first two performance years, the Pioneer Model tests a shared savings and shared losses payment arrangement with higher levels of reward and risk than in the Shared Savings Program. These shared savings would be determined through comparisons against an ACO’s benchmark, which is based on previous CMS expenditures for the group of patients aligned to the Pioneer ACO. In year three of the program, those Pioneer ACOs that have shown savings overthe first two years will be eligible to move to a population-based payment model. Population-based payment is a per-beneficiary per month payment amount intended to replace some or all of the ACO’s feefor-service (FFS) payments with a prospective monthly payment. Additionally, during the application process, organizations were invited to propose alternative payment arrangements. CMS established two alternatives to the core payment arrangement discussed above based on this input. Both of these alternatives follow a shared savings model in years one and two, and provide an option for a partial population based payment that removes limits on rewards and risks in year three. These arrangements will allow Pioneer ACOs more flexibility in the speed at which they assume financial risk.
Fewer ED / Hospital Visits:
JAMA (May 2015) study of 600,000 patients assistned to a Pioneer ACO in 2012 or 2013
- Acute inpatient days per 1000 beneficiary months decreased more for ACOs than for the comparison group in 2012 (−0.05 days [95% CI, −0.065 to −0.039]) and 2013 (−0.02 days [95% CI, −0.029 to −0.004])
- Differences in emergency department visits and inpatient admissions through the emergency department were statistically significant and either decreased more or increased less in 2012 and 2013
Improved Health:
CMS Fact Sheet (August 2015) based on an evaluation of 2014 quality and financial performance results
- The ACOs showed improvements in 28 of 33 quality measures and experienced average improvements of 3.6% across all quality measures compared to Performance Year 2.
- Particularly strong improvement was seen in:
- medication reconciliation (70% to 84%)
- screening for clinical depression and follow-up plan (50% to 60%)
- qualification for an electronic health record incentive payment (77% to 86%)
Government Accountability Office (April 2015) report evaluated 23 ACOs that participated in the Pioneer Model in 2012 and 2013
- Pioneer ACOs had significantly higher quality scores in the second year than in the first year for two-thirds of the quality measures (22 of the 33, or 67 percent)
- Significantly higher scores for measures in care coordination and disease management for at-risk populations.
CMS Fact Sheet (September 2014) (Results for second performance year)
- The mean quality score among Pioneer ACOs increased by 19 percent, from 71.8 percent in 2012 to 85.2 percent in 2013
- The organizations showed improvements in 28 of the 33 quality measures and experienced average improvements of 14.8 percent across all quality measures. Some of these measures included controlling high blood pressure, screening for future fall risk, screening for tobacco use and cessation, and patient experience in health promotion and education
Improved Patient/Clinician Satisfaction:
CMS Fact Sheet (August 2015) based on an evaluation of 2014 quality and financial performance results
- Pioneer ACOs improved the average performance score for patient and caregiver experience in 5 out of 7 measures compared to Performance Year 2
JAMA (May 2015) study of 600,000 patients assistned to a Pioneer ACO in 2012 or 2013
- Compared with other Medicare beneficiaries, Pioneer ACO-aligned beneficiaries reported higher mean scores for timely care (77.2 [ACO] vs 71.2 [FFS] vs 72.7 [Medicare Advantage]) and for clinician communication (91.9 [ACO] vs 88.3 [FFS] vs 88.7 [Medicare Advantage])
Government Accountability Office (April 2015) report evaluated 23 ACOs that participated in the Pioneer Model in 2012 and 2013
- Pioneer ACOs had significantly higher scores for measures of patient experiences of care
CMS Fact Sheet (September 2014) (Results for second performance year)
- Improved the average performance score for patient and caregiver experience in 6 out of 7 measures. These results suggest that Medicare beneficiaries who obtain care from a provider participating in Pioneer ACOs report a positive patient and caregiver experience
Improved Access:
JAMA (May 2015) study of 600,000 patients assistned to a Pioneer ACO in 2012 or 2013
- "Despite differential decreases in primary care office visits for evaluation and management, hospital discharge follow-up visits within 7 days had significant differential increases from 11.3 (95% CI, 4.6 to 18.0) visits per 1000 discharges in 2012 to 14.8 (95% CI, 8.5 to 21.0) visits per 1000 discharges in 2013 for beneficiaries aligned with ACOs."
- "A significant differential increase was also seen in 2013 for follow-up visits within 14 days of discharge (10.7 [95% CI, 4.9 to 16.4] per 1000 discharges) but not within 30 days in either year."
Cost Savings:
CMS Fact Sheet (August 2015) based on an evaluation of 2014 quality and financial performance results
- Pioneer participants saved $120 million in 2014, compared with $96 million in 2013
- Of 15 Pioneer ACOs who generated savings, 11 generated savings outside a minimum savings rate and earned a total shared savings of $82 million.
- Of 5 Pioneer ACOs who generated losses, 3 generated losses outside a minimum loss rate and owed a total of $9 million in shared losses to CMS
- Total model savings per ACO increased from $2.7 million per ACO in Performance Year 1 to $4.2 million per ACO in Performance Year 2 to $6.0 million per ACO in Performance Year 3
JAMA (May 2015) study of 600,000 patients assistned to a Pioneer ACO in 2012 or 2013
- ~$36 reduction PMPM in 2012 and ~$11 reduction PMPM in 2013 for patients attributed to a Pioneer ACO vs non-affiliated patients
- The rate of savings was 4 percent in the first year, or a total of $212 million, and less than 1.5 percent, or $105 million in the second year
Government Accountability Office (April 2015) report evaluated 23 ACOs that participated in the Pioneer Model in 2012 and 2013
- Forty-one percent of the ACOs produced $139 million in total shared savings in 2012, and 48 percent produced $121 million in total shared savings in 2013.
- In 2012 and 2013 CMS paid ACOs $77 million and $68 million, respectively, for their shared savings.
- The Pioneer ACO Model produced net shared savings of $134 million in 2012 and $99 million in 2013.
CMS Fact Sheet (September 2014)
- During the second performance year, Pioneer ACOs generated estimated total model savings of over $96 million and at the same time qualified for shared savings payments of $68 million. They saved the Medicare Trust Funds approximately $41 million. The total model savings and other financial results are subject to revision.
- Pioneer ACOs achieved lower per capita growth in spending for the Medicare program at 1.4 percent, which is about 0.45 percent lower than Medicare fee-for-service.
- Eleven Pioneer ACOs earned shared savings, 3 generated shared losses, and 3 elected to defer reconciliation until after the completion of performance year three.
CMS Press Release (January 2014)
- CMS Pioneer ACOs generated gross savings of $147 million in their first year while continuing to deliver high quality care.
- Results showed that of the 23 Pioneer ACOs, nine had significantly lower spending growth relative to Medicare fee for service while exceeding quality reporting requirements.
Increased Preventive Services:
Government Accountability Office (April 2015) report evaluated 23 ACOs that participated in the Pioneer Model in 2012 and 2013
- Pioneer ACOs had significantly higher scores for measures of preventive health care
Other Outcomes:
Health Affairs blog (May 2014)
The Pioneer program generated $147 million in total savings with approximately $76 million in savings returned to ACOs. Of the original 32 Pioneer ACOs, 12 shared in savings while 19 did not share in savings or losses. Only one ACO shared in losses
Final Report (December 2016)
https://innovation.cms.gov/Files/reports/pioneeraco-finalevalrpt.pdf
Last updated August 2018
