Pioneer ACO vs shared savings model

CMS announced in late December that 32 organizations had been selected to participate in the Pioneer ACO Model. The organizations vary in size, scope and region, and included Arizona-based Banner Health, Colorado-based Physician Health Partners, and Massachusetts-based Beth Israel Deaconess Physician Organization.

According to CMS, the Pioneer ACO Model was designed specifically for organizations with experience offering coordinated, patient-centered care, and operating in ACO-like arrangements. “The selected organizations were chosen for their significant experience offering this type of quality care to their patients,” CMS said. “These organizations were selected through an open and competitive process from a large applicant pool that included many qualified organizations.”

“Pioneer ACOs are leaders in our work to provide better care and reduce health care costs,” said Secretary Sebelius. “We are excited that so many innovative systems are participating in this exciting initiative – and there are many other ways that health care providers can get involved and help improve care for patients.”

 

The Pioneer ACO Model differs from the Medicare Shared Savings Program in the following ways, according to CMS:

• The first two years of the Pioneer ACO Model are a shared savings payment arrangement with higher levels of savings and risk than in the Shared Savings Program.

• Starting in year three of the initiative, those organizations that have earned savings over the first two years will be eligible to move to a population-based payment arrangement and full risk arrangements that can continue through optional years four and five.

• Pioneer ACOs are required to develop similar outcomes-based payment arrangements with other payers by the end of the second year, and fully commit their business and care models to offering seamless, high quality care.

 

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