‘Pioneers Take Arrows While Settlers’ Get the Land?’

At the ACO Summit in Washington DC in June 2012 Elliott Fisher, MD arguably one of the admitted father’s of the ACO movement opined perhaps prophetically from a panel including Mark McClellan, MD and former Health Affairs Editor, now RWJF Senior Health Policy Advisor Susan Dentzer the above wisdom.Richard Gilfillan MD

Today, CMS via the Center for Medicare and Medicaid Innovation (CMMI) released their eagerly anticipated results for the Pioneer class, i.e., that risk savvy group of participants most likely to make the accountable care vision work. Unfortunately as was the case in the predecessor Physician Group Practice (PGP) demonstration sample, the results where well ‘mixed’ with several exiting the program entirely while other’s chose to default to the ‘tamer’ Medicare Shared Savings Program.

According to Modern Physician:

Seven Medicare Pioneer accountable care organizations that didn’t produce savings in the first year of the Obama administration’s most ambitious test of the accountable care model have told the CMS they will leave the Pioneer program and enter the Medicare Shared Savings Program model, while another two participants have indicated they will leave Medicare accountable care entirely, the federal agency announced Tuesday.

The American Medical Group Association (AMGA) also released the following statement:

…regarding the announcement from the Centers for Medicare & Medicaid Services (CMS) on first-year results from the Center for Medicare and Medicaid Innovation’s Pioneer ACO Program (25 of the 32 health systems in the program are AMGA members):

“AMGA member groups are in the forefront of transforming the nation’s healthcare delivery system to achieve coordinated, affordable, high-quality care. AMGA is always proud to highlight the groundbreaking and innovative steps our members have taken, and continue to take, in order to improve the quality of our nation’s healthcare system, but today we are particularly pleased to congratulate members in the Pioneer ACO program for improving patient care and in some cases lowering the cost of care. All of these groups are to be applauded for their leap of faith and their continued dedication to advancing the role of high-performing health systems in America. ”

As with any ambitious effort of this scale, the movement to value-based, accountable, coordinated care for patients is an evolutionary process. Programs like ACO initiatives will take many years to mature, especially because they are creating and testing new models for payment and care delivery. AMGA is encouraged by the achievements of the Pioneer ACO participants in the first year of the program. We also pledge our continued support of our members that are committed to promoting better health care at lower costs in the Pioneer ACO and Medicare Shared Savings programs. ”

Many AMGA medical groups, and in particular the ACO Pioneers, are laying the foundation for future programs and innovative payment arrangements. These medical groups will continue to invest in improvements in care processes and infrastructure that will provide patients with better health outcomes, enhanced care experience, and lower costs well into the future. AMGA commends all of our members who have undertaken this journey. – Donald W. Fisher, Ph.D., CAE, AMGA President and Chief Executive Officer

The CMMI announcement reads in part as follows:

Today, the Centers for Medicare & Medicaid Services (CMS) announced positive and promising results from the first performance year of the Pioneer Accountable Care Organization (ACO) Model, including both higher quality care and lower Medicare expenditures. Made possible by the Affordable Care Act, the Pioneer ACO Model encourages providers and caregivers to deliver more coordinated care for Medicare beneficiaries. This model, launched by the CMS Innovation Center, is part of the Affordable Care Act’s efforts to realign payment incentives, promoting high quality, efficient care for Medicare beneficiaries. ACOs, including the Pioneer ACO Model and the Medicare Shared Savings Program, are one way CMS is providing options to providers looking to better coordinate care for patients and use health care dollars more wisely.

“These results show that successful Pioneer ACOs have reduced costs for Medicare and improved the quality of care for their patients,” said CMS Administrator Marilyn Tavenner. “The Affordable Care Act has given us a wide range of tools to realign payment incentives in Medicare and Medicaid, and these efforts are already paying off.”

For the complete CMMI announcement with exit rational and implications for the program, click here.


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