One of the key features of the Pioneer program, and one that differentiates it from the Medicare Shared Savings Program, is that it is accountable for all Medicare A and B benefits, says Emily Brower, executive director of accountable care programs at Atrius Health, one of 23 remaining participants in the CMS Pioneer ACO program.
I want to point out some key features of the CMS ACO Pioneer model that will be helpful in understanding why Atrius Health picked the initiatives it did to focus on in our first year. The contract itself is initially a three-year contract; if both Medicare and the ACO agree, it can continue for another two years, or a total of three to five years.
One important feature is that a Pioneer ACO is accountable for all Medicare A and B benefits, which is slightly different from your Medicare Advantage contract. It includes the dual-eligible beneficiaries, patients with end stage renal disease (ESRD) and those with the hospice benefit.
CMS offers two Medicare ACOs: one is the Pioneer ACO, and the other is the Medicare Shared Savings Program (MSSP) ACO. We were interested in the Pioneer model because it lives within the Center for Medicare/Medicaid Innovation. That center is staffed with people who we felt really understood the issues that we faced in being accountable for care across the continuum and were content experts in ways that we thought would make the program successful.
The other important feature that differentiates the two programs is that in the Pioneer ACO, patients are prospectively aligned to the ACO. There’s a process of looking back and asking, who are the patients that are getting their primary care from the ACO? We then have that cohort of patients to manage across the continuum and over time. It’s different from the Medicare Shared Savings Program ACO, which is a retrospective alignment.
Some other features important to the program: the budget and how performance is measured, the fact that the Pioneer ACO model shares both up and downside risk with Medicare; and the importance of the quality measures. There are other obligations with some ‘softer’ qualities of an ACO that Medicare is looking for, such as patient-centered care, valuing patient preferences, use of evidence-based practices, and participation in the learning collaborative.
Profile of a Pioneer ACO: Atrius Health’s Lessons in Risk Management and Accountable Care provides first-year advice from Atrius Health’s accountable care organization, one of 23 remaining participants in the CMS Pioneer ACO program that is testing alternative payment and program design models for accountable care organizations.