The Centers for Medicare & Medicaid Services said performance data for the first year of Pioneer accountable care organizations shows higher-quality care and lower expenditures for aligned Medicare beneficiaries.
As codified by the Affordable Care Act, the Pioneer ACO model encourages providers and caregivers to deliver more coordinated care for Medicare beneficiaries.
The model is part of the effort in healthcare reform to realign payment incentives and promote high-quality, efficient care for Medicare beneficiaries. Participating healthcare organizations share in Medicare savings or are liable for a portion of losses.
All 32 Pioneer ACOs successfully reported quality measures and achieved the maximum reporting rate for the first performance year, 2012, with all earning incentive payments for their reporting, according to CMS. Overall, Pioneer ACOs performed better than published rates in fee-for-service Medicare for all 15 clinical quality measures for which comparable data are available. (Seven measures had no comparable data in the published literature.)
For example, 25 of 32 Pioneer ACOs generated lower risk-adjusted readmission rates for their aligned beneficiaries than the benchmark rate for all Medicare fee-for-service beneficiaries.
Pioneer ACOs performed better on clinical quality measures that assess hypertension control for patients. The median rate among Pioneer ACOs on blood pressure control among beneficiaries with diabetes was 68% in 2012, compared with 55% as measured in an adult diabetic population in 10 managed care plans across seven states from 2000 to 2001.
Pioneer ACOs performed better on clinical quality measures that assess low density lipoprotein control for patients with diabetes. The median rate among Pioneer ACOs for LDL control among beneficiaries with diabetes was 57% in 2012, compared with 48% in an adult diabetic population in 10 managed care plans across seven states from 2000 to 2001.
Costs for the more than 669,000 beneficiaries aligned to Pioneer ACOs grew by 0.3% in 2012, whereas costs for similar beneficiaries grew by 0.8% during the same period. Thirteen of 32 Pioneer ACOs produced shared savings with CMS, generating a gross savings of $87.6 million in 2012 and saving nearly $33 million to the Medicare Trust Funds.
Pioneer ACOs earned more than $76 million by providing coordinated, quality care. Only two Pioneer ACOs had shared losses, totaling approximately $4 million. Program savings were driven, in part, by reductions that Pioneer ACOs generated in hospital admissions and readmissions.
Pioneer ACOs have taken tangible steps to improve care while lowering costs. For instance, Banner Health Network, based primarily in the Southwest, dispatches hospital-trained nurses to patients homes to perform tasks such as managing prescription drugs, taking blood-sugar readings, teaching healthy eating habits and even arranging delivery of a motorized wheelchair.
Monarch HealthCare ACO offers a care coordination service for beneficiaries who need assistance with coordinating the medications and many care visits associated with having multiple diagnoses.
Pioneer ACOs were rated higher by ACO beneficiaries on all four patient experience measures when compared with 2011 Medicare fee-for-service results.
Seven Pioneer ACOs that did not produce savings have notified CMS they intend to apply to the Medicare Shared Savings Program, an ACO model with lower shared savings and risk than the Pioneer model. Two Pioneer ACOs have indicated to CMS their intent to leave the program.
Overall, more than 250 organizations participate in the Pioneer ACO Model and the Medicare Shared Savings Program, serving 4 million Medicare beneficiaries, and more ACOs can join the Shared Savings Program each January.
More information about Pioneer ACOs: http://innovation.cms.gov/initiatives/Pioneer-ACO-Model/.