Banner Health Network - CMS Pioneer ACO

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.

Robust quality measures and other criteria as reward incentives will also be applied to BHN’s partnerships with Health Net and Aetna, which will utilize the emerging population health management model. In these partnerships, reimbursement for services occur solely through monthly premiums paid by organizations and members enrolled for network medical care. There is no additional revenue beyond the premiums. As a result, network providers are incentivized to work in a highly collaborative, innovative manner to focus on wellness, coordinating care and providing services as efficiently as possible. This can result in costs for services being less than the premiums available within the network. These “shared savings” are then divided among the network providers as net revenue.