The Pioneer Accountable Care Organization (ACO) Model has generated over $384 million in savings to Medicare over its first two years — an average of approximately $300 per participating beneficiary per year — and significantly decreased inpatient care, while continuing to deliver high-quality patient care, according to HHS.
Initially established to further healthcare’s transition to value-based reimbursement and care for Medicare beneficiaries, the Pioneer ACO will be scaled into other Medicare programs, HHS states. The agency recently announced it will tie 30 percent of Medicare payments to quality and value through alternative payment models by 2016 and 50 percent of payments by 2018. More than 3,600 payors, providers, employers, patients, states, consumer groups, consumers and other partners have registered to participate in the Health Care Payment Learning and Action Network, which was launched to help the healthcare system reach these goals.
Currently, the Pioneer ACO Model serves more than 600,000 Medicare beneficiaries. According to the HHS, compared to their counterparts in regular fee-for-service or Medicare Advantage plans, Medicare beneficiaries who are in Pioneer ACOs, on average:
- Report more timely care and better communication with their providers;
- Use inpatient hospital services less and have fewer tests and procedures, and
- Have more follow-up visits from their providers after hospital discharge.
Pioneer ACOs generated Medicare savings of $279.7 million in 2012 and $104.5 million in 2013. To date, actuarial analyses show that ACOs in the Pioneer ACO Model and the Medicare Shared Savings Program have generated over $417 million in total program savings for Medicare. Primary analysis can be found in an article published in the Journal of the American Medical Association (JAMA).
Source: HHS May 4, 2015
Tactics from a Top-Performing Pioneer ACO: Engaging Patients and Providers in Accountable Care provides first-year advice from Monarch HealthCare’s Medicare accountable care organization, one of 32 original CMS Pioneer ACOs engaged to test alternative payment and program design models for accountable care organizations. Colin LeClair, executive director of ACO for Monarch HealthCare, recounts in this 30-page resource the challenges, results and learnings from its first 12 months as a Pioneer ACO, including the IPA’s interest in redefining care coordination boundaries.