Posts Tagged ‘Pioneer ACO’

2016 ACO Results: Majority of Next Generation and Pioneer ACOs Earn Shared Savings

October 20th, 2017 by Patricia Donovan

Six of eight Pioneer ACOs and eleven of eighteen Next Generation ACOs earned shared savings in separate initiatives in 2016, according to newly released quality and financial data from the Centers for Medicare and Medicaid Services (CMS).

In 2016 Performance Year Five of the Pioneer ACO program, one of several new accountable care organization (ACO) payment and service delivery models introduced by CMS to serve a range of provider organizations, only Monarch HealthCare and Partners HealthCare were not among shared savings earners.

Banner Health Network emerged as the top 2016 Pioneer ACO performer, earning nearly $11 million in shared savings based on care provided to its more than 42,000 beneficiaries.

In order to receive savings or owe losses in a given year, Pioneer ACO expenditures must be outside a minimum corridor set by the ACO’s minimum savings rate (MSR) and minimum loss rate (MLR).

The Pioneer ACO model is designed for healthcare organizations and providers already experienced in coordinating care for patients across care settings. It allowed these provider groups to move more rapidly from a shared savings payment model to a population-based payment model on a track consistent with but separate from the Medicare Shared Savings Program (MSSP).

The Pioneer ACO Model began with 32 ACOs in 2012 and concluded December 31, 2016 with eight ACOs participating.

Meanwhile, at the conclusion of 2016 Performance Year One of the Next Generation ACO model, Baroma, Triad and Iowa Health topped the list of ACO earners in this program, with each organization accumulating more than $10 million shared savings.

Building upon experience from the Pioneer ACO Model and the Medicare Shared Savings Program, CMS’s Next Generation ACO Model sets predictable financial targets, enables providers and beneficiaries greater opportunities to coordinate care, and aims to attain the highest quality standards of care.

According to a CMS fact sheet, 18 ACOs participated in the Next Generation ACO Model for the 2016 performance year, and 28 ACOs are joining the Model for 2017, bringing the total number of Next Generation ACOs to 45. The Next Generation ACO Model will consist of three initial performance years and two optional one-year extensions.

CMS’s ACO models are one of seven Innovation categories designed to incentivize healthcare providers to become accountable for a patient population and to invest in infrastructure and redesigned care processes that provide for coordinated care, high quality and efficient service delivery.

What’s the Future of Accountable Care Organizations?

December 22nd, 2015 by Patricia Donovan

CMS launched its Pioneer ACO program in 2012, designing the initiative for early adopters of coordinated care who tend to be more experienced, have an established care coordination infrastructure, and assume greater performance-based financial risk. Following the departure of several healthcare organizations in 2015 from the Medicare Pioneer ACO program, the Healthcare Intelligence Network asked some industry thought leaders what these actions signal for the remaining Pioneer ACOs, other ACO programs and accountable care organizations in general.

(Laura Jacobs, executive vice president, Healthcare Camden Group) The flaws in the ACO model are becoming apparent as organizations are moving into the second and third years of their profiles, of their contracts. That’s the big challenge for the ACO model in general. The big wins in many cases for the ACOs were in markets where the costs were very high to begin with, and organizations were able to achieve their savings relatively easily. Some organizations weren’t even sure what they did to generate savings. But once you get into the second and third years, it becomes harder and harder to continue to achieve the performance thresholds.

That says that the ACO model in its current form must continue to evolve. We must think about how to get the data, how to deal with patient attribution, and how to manage in an environment where the savings will become increasingly difficult to achieve the further along you get. I see the ACO model as a model that will probably evolve to something else. One of the ideas in the Next Generation ACO is to try and continue to tweak that model. I think we’ll continue to see that on both the Medicare side and the commercial side; to see how this ACO structure continually needs to be modified.

(Paul H. Keckley, Ph.D., managing director, Navigant Center for Healthcare Research and Policy Analysis) CMS is doubling down on ACOs. Look at how CMS has pitted ACOs as part of its future. The ACO has the organizing framework, especially around strong primary care provider organizations. Then, sitting beside it are bundled payments, which become the organizing principle for specialists in hospitals on the inpatient side. It’s a pretty interesting Yin-Yang. All the indications from the hill are that this is the future; this is the track that’s been set for these alternative payments.

I think Laura is right. They’ll keep tweaking the program. They’ve doubled down on it, they’ve added three new programs to the first ones. The ACO is here to stay.

Source: Healthcare Trends & Forecasts in 2016: Performance Expectations for the Healthcare Industry

Healthcare Trends & Forecasts in 2016: Performance Expectations for the Healthcare Industry, HIN’s 12th annual business forecast, pins down the trends destined to impact the industry in the year to come and proposes tactics C-suite executives can employ to distinguish their operations in a dynamic marketplace.

Steward Medicare Pioneer ACO ‘Patient Trackers’ Boost Care Management, Improve Performance

July 14th, 2015 by Patricia Donovan

Steward Medicare Pioneer ACO

Steward's Medicare Pioneer ACO was a top performer in performance year two, with gross savings of $19.2 million.

The ability to track patients across a continuum of care sites is a perennial challenge for healthcare organizations—even a top-performing Medicare Pioneer ACO.

“We can’t prevent a readmission back to the hospital or redirect unnecessary emergency department visits if we don’t know the patients were in the hospital to begin with,” noted Kelly Clements, Pioneer program director at Steward Healthcare Network, during Medicare Pioneer ACO: Care Management, Quality Improvement and Data Integration Yields Substantial Performance Gains, a Healthcare Intelligence Network webinar now available for replay.

But Steward’s Medicare Pioneer ACO meets this challenge head-on with two tools: a home-grown patient surveillance tracker, and the “Patient Ping” service that provides real-time patient admissions and discharge notifications to providers. Both tools help Steward to identify and coordinate care for Pioneer ACO beneficiaries who seek services from both Steward and non-Steward providers.

These innovations have helped Steward’s Medicare Pioneer ACO, aptly named Promise (“For our promise to do the best we can to coordinate beneficiaries’ care and increase quality of care,” said Ms. Clements), to emerge as one of the top CMS Medicare Pioneer ACO performers in 2013, with gross savings of $19.2 million.

Three Medicare Pioneer ACO Challenges

Care management, including the tracking of its 80,000 Promise beneficiaries, was one of three categories of Medicare Pioneer ACO challenges Ms. Clements touched on during the webinar, along with physician engagement and performance improvement.

Supporting care management, the internally developed patient surveillance tracker is Steward’s in-network solution for real-time tracking of care received from Steward providers and facilities; the contracted Patient Ping service allows the Pioneer ACO to communicate with skilled nursing facilities (SNFs) outside their network that care for Steward Pioneer patients, providing the SNF is registered with Patient Ping.

“Through the Pioneer program, we’ve learned that a large portion of our opportunity to reduce cost and achieve savings as an ACO is in the post-acute care space, particularly in the SNFs,” noted Ms. Clements.

To engage physicians in the delivery of accountable care, Steward has done everything from holding road shows for providers to creating performance improvement teams for each geographic “chapter” in the ACO to work with physician practices to improve efficiency and quality. Physician report cards measure stewardship (including attendance at chapter meetings) and other efficiency and quality indicators.

And finally, to drive performance improvement, Steward has worked aggressively on data integration, with a strong focus on the two most popular electronic health records (EHRs) its physician network, in order to feed its ‘quality data warehouse.’

This focus, along with efforts by the physician practices, has generated results. Steward saw its Pioneer ACO raw quality scores rise significantly from performance year one to performance year two: a 39 percent jump in the preventive health domain, and a 42 percent improvement in the at-risk domain (care for chronic conditions such as diabetes and coronary artery disease (CAD).

There is one additional hurdle: Steward must decide which ACO program it will participate in next year: Pioneer ACO, Next Generation ACO or Medicare Shared Savings Program (MSSP), Track 3. “The more efficient we become, the harder it will be to achieve shared savings, because the benchmark will keep getting lower, so this is one of our big concerns,” said Ms. Clements.

“Our leadership is fully committed to pursuing risk aggressively and it’s been worthwhile being at the table with Medicare and advocating for programmatic changes that will benefit our providers and patients in a sustainable way.”

4 Trends for Healthcare Providers in 2014

January 30th, 2014 by Jessica Fornarotto

Dual-track medical homes, e-visits, retooled patient handoffs and more post-acute care are predicted provider trends for 2014, according to Steven Valentine, president of The Camden Group. HIN interviewed Valentine prior to his presentation during an October webinar on Healthcare Trends & Forecasts in 2014: A Strategic Planning Session.

HIN: What is the physician practice going to look like in 2014? How has the primary care team evolved to meet the Triple Aim values inherent in the PCMH and accountable care models?

(Steven Valentine): We should expect to continue to see consolidation amongst the medical groups. The independent practice associations will begin to assimilate together because they need to put more money into their infrastructure. And many of the organizations have underperformed, in all honesty.

The primary care team is still critical. We’ve benefitted by keeping many primary care doctors around because they were negatively hurt with their net worth in the recession in 2008-2010. But it’s slowly coming back and we’re starting to see those physicians thinking about retirement again. The reality is, we’re never going to replace all of these primary care doctors as they wind down their practice. We need to do a better job of getting telehealth going and utilizing e-visits. We’re seeing the health plans starting to pay for those e-visits, as well as having the consumer who uses them use a credit card and pay at that time, just like a visit.

We’re going to have to look at different models. Obviously, the nurse practitioner is getting more involved with the primary care. And yes, they’re still pursuing the Triple Aim. We know that quality scores, satisfaction scores and trying to manage cost per unit is still a critical focus of the triple aim moving forward with population health.

Lastly, with a PCMH in accountable care, while some of the pioneer accountable care organizations (ACOs) reduce themselves out of pioneer into the Medicare Shared Savings Program (MSSP), we still have a number of organizations and it’s growing. The commercial ACOs have been very successful in California.

We fully expect accountable care to continue. We think the PCMH will evolve into two tracks. The first track is a primary care PCMH. The spinoff is a chronic care medical home that has the multidisciplinary team organized around a chronic disease. This is a model developed by CareMore years ago in Southern California and it’s been expanded across the country. As I travel the country, I run into organizations that have set up these chronic care centers around the chronic disease.

HIN: Regarding the Pioneer ACO program, one of the top performers in the CMS pioneer program, Monarch HealthCare, told us that it’s going to be working to engage specialists in care coordination roles in year two and year three. What’s ahead for specialists in terms of quality and performance improvement as well as shouldering perhaps more care coordination duties, especially for Medicare patients?

(Steven Valentine): The specialists are going to be a critical piece to this whole solution. They have been a tremendous asset in the area of bundled payments, where you have the facility fee and physician fee combined into one payment. That works for both the Medicare as well as the commercial side. You’re beginning to see more of the bundled payments within an ACO.

The ACO manages what we call ‘frequency’ — in other words, the number of procedures to be done. Specialists are involved in satisfaction, quality scores, and resource consumption once the decision is made that the procedure needs to be done.

We expect the specialists to be involved with quality and performance. Everybody is putting in incentive programs to help drive higher quality, better performance, and a lower cost.

HIN: Hospitals have tightened the patient discharge process as a means of shoring up care transitions. But what other work needs to be done in terms of collaborations, perhaps with skilled nursing facilities (SNFs), long-term care and home health, for example, to improve patient handoffs and reduce hospital readmissions?

(Steven Valentine): Handoffs have probably been one of the areas where we’ve seen the most disappointment or underperformance within many ACOs. They have not effectively involved the hospitalists and the care/case managers who are typically embedded within the medical group that would oversee the patient throughout the care continuum. Or if it’s a health system, emanate centralized care/case management function where they manage all of the transitions from pre-acute, acute to post-acute. We think this will get better. As the doctors are more at risk, they will get more engaged with the care/case managers to manage these transitions and handoffs.

We also know that, while not in 2014 but the trend will start, we’ll see lower acute care utilization, pushing more patients to post-acute care. This means, in any given area, acute care hospitals will begin to convert excess capacity to post-acute care services like skilled nursing, long-term care, palliative care, hospice care, home care and rehab care. You will begin to see a closer proximity. The care managers will be able to work more effectively with the doctors and hospitals to manage the patient through the continuum, smooth out these transitions and have a better patient experience with better satisfaction scores at a lower cost.

Excerpted from: Healthcare Trends & Forecasts in 2014: Performance Expectations for the Healthcare Industry

Pioneer ACO to Specialists: If the Care Coordination Role Fits, Wear It

September 24th, 2013 by Patricia Donovan

Monarch HealthCare took top honors in quality performance in year one of the CMS Pioneer ACO program.

As far as Medicare beneficiaries are concerned, it’s time for healthcare to acknowledge specialists as principal caregivers of the chronically ill, advises Monarch HealthCare, a top-performing CMS Pioneer ACO.

Monarch came to this realization in year one of participation in CMS’s Pioneer ACO program, when it discovered that 70 to 80 percent of office visits by its 14,000 accountable care organization (ACO) patients were to specialists.

“We have to start treating [specialists] like a primary care provider (PCP), especially for those patients that are chronically ill, where it is actually appropriate that a cardiologist is the primary care giver for a patient with CHF and coronary artery disease (CAD),” said Colin LeClair, Monarch HealthCare’s executive director of ACO.

Engaging and incentivizing specialists in its ACO are two key facets of Monarch’s year three performance strategy, noted LeClair during a recent webinar on Medicare Pioneer ACO Year One: Lessons from a Top-Performer. Going forward, Monarch plans to tap patient data from specialist encounters to enhance its care management and quality improvement efforts.

Despite its regret at not engaging specialists earlier, Monarch’s Pioneer ACO has plenty to be pleased about at the outset of year two, in which the number of ACO-attributed patients has swelled to 22,000 patients.

In terms of quality performance, Monarch, the largest IPA in Orange County, Calif., was year one’s top scorer in several patient-centered metrics in the Pioneer ACO program, and the second highest performer in the area of medical cost reduction — a result largely driven by reductions in hospital and skilled nursing facility (SNF) utilization and unit costs, noted LeClair.

Monarch is one of 32 originally selected CMS Pioneer ACOs. Today, 23 remain in the program.

During the 45-minute program, LeClair outlined Monarch’s six-step ACO implementation strategy, a patient-centered approach built around risk stratification, ACO team-building, and care management. Trial and error during the first year yielded some interesting findings, such as the optimal time to engage a patient, he said.

Among the four success drivers LeClair shared was a coterie of Web-based population health management tools Monarch developed for its ACO team, he said, that are supported with Web and face-to-face training.

One such tool is the annual senior health risk assessment (ASHA) reviewed by the patient and doctor during the Medicare Annual Wellness Visit. The free annual well visit provides an opportunity to identify key risk factors, perform screenings and reconcile medications.

Unfortunately, the new CMS benefit is largely unfamiliar to patients, LeClair added.

Another year one lesson learned was the value of the office staff in ACO rollout. As Monarch tweaks its ACO architecture, it is considering incentivizing the office staff as well. “Too often, incentives are focused on the physicians, and the office staff actually drives most of the work to support the ACO population,” said LeClair.

In closing, LeClair said Monarch remains committed to the ACO model, and as it looks ahead to year three, it hopes to identify mini-networks of physicians, explore episodic or bundled payments, and partner with hospitals, SNFs and ancillary vendors to reduce avoidable utilization.

Click here to listen to an interview with Colin LeClair.

High-Risk Patient Roster Helps Atrius Pioneer ACO ‘Beat the Benchmark’

May 17th, 2013 by Patricia Donovan

Webinar Replay: Lessons from Atrius Health Pioneer ACO

They don’t call them pioneers for nothing.

A high-risk patient roster, a retooled geriatric care model and a preferred SNF network are just a few Atrius Health innovations on the healthcare frontier.

Atrius Health is one of 32 participants in the CMS Pioneer ACO program testing alternative payment and program design models for accountable care organizations. Emily Brower, Atrius Health executive director of accountable care programs, shared first-year lessons during a recent webinar, Medicare Pioneer ACO: Case Study on Atrius Health’s Focus on the Triple Aim.

Atrius was drawn to the three-year Pioneer ACO program for a number of reasons. First, it offered the non-profit alliance of six independent medical groups a chance to showcase its core competencies, including its rich data environment, foundation in the patient-centered medical home (PCMH) model and new home care services, Ms. Brower said.

Also, it gave the Massachusetts organization a chance to build a population-based approach to managing its Medicare population as a whole, with Triple Aim goals as a foundation.

And finally, they had a lot of faith in the staff of the CMS Center for Medicare/Medicaid Innovation, where the project resides. “We feel they really understand the issues we face in being accountable for care across the continuum,” noted Ms. Brower.

The Pioneer ACO shared savings and loss model challenges participants to perform against nationally identified trends. CMS take a participating ACO’s population and creates from the national Medicare database a reference population, she explained. “We’re trying to beat the trend in that national population, or ‘beat the benchmark.'”

In 2012, Atrius launched six clinical and technical initiatives to address the program’s 33 quality measures — “the gate through which the ACO achieves savings.” Key among them is its eight-step high-risk patient roster review, a hallmark of Atrius’s redesigned geriatric care model.

“We used a new risk stratification tool to identify our high-risk patients, who go on a roster reviewed by a multidisciplinary team in the primary care practice to identify care gaps, including a need for advance directives.” One outcome of the roster’s use has been an increase in end-of-life conversations, she says.

On the technical support side, Atrius Health developed new tools within its EPIC® electronic health record (EHR) for tracking quality efforts, advanced care planning, medication reconciliation and other key metrics.

Ms. Brower estimates the total investment to launch the ACO, including the EHR, quality measurement tools and other efforts, to be between $2 and $3 million; the medical groups themselves likely spent that much again for additional care management resources.

“In terms of payback, we expect that we will be able to reduce the cost of care — to bend the cost curve so that we are beating the benchmark and creating savings that then support our additional investments.”

Among programs on the drawing board: new ways to use the geriatric well visit, a home-based primary care program for high-risk patients, two programs for dual eligibles, and a patient advisory group.

Atrius Health is committed to the Pioneer ACO program, despite concerns from some participants over the program’s quality measurement process communicated to CMS last month. “We know it’s going to take time. As we would say, ‘We’re not called pioneers for nothing.’ It took us that first year to identify develop most of the tools and infrastructure that CMS needed.”

She continues: “The new measures that I mentioned that are coming out of the EHR being reported directly to CMS — that piece that we had to put together. There just wasn’t an existing pool of data to build benchmarks for those measures. Now that we have data, CMS will use this to create empirical benchmarks, which was one of the recommendations in that Pioneers communication.”

Listen to an audio interview with Atrius Health’s Emily Brower.

Guest Post: Accountable Care as a Panacea

April 22nd, 2013 by Ally C. Evans


ACOs are testing ways to disrupt the high-cost culture of healthcare.

In the final post of a three-part series on “Accountable Care: The Power of Partnerships,” guest blogger Ally C. Evans, healthcare consultant with Freed Associates, makes the case for ACOs as a solution.

Because ACOs are in a state of evolutionary fluidity, it is too early to know if they will cure our fragmented delivery system woes, but they certainly have potential. We know this because although the term ‘ACO’ is relatively new, the concept itself is not. The likes of Kaiser Permanente, the Mayo Clinic and the Cleveland Clinic have operated under the principles of integration, population health management and accountability for a long time. In fact, they are so good at it that they’re really more like Super ACOs. They have developed highly sophisticated, centralized practices, IT systems and care networks that connect patients to the right services at the right time to optimize outcomes, the patient experience and service utilization. As a result, they have emerged as some of the top healthcare brands in the country and provide best-practice examples to inform ACO strategy and tactical implementation.

The major benefits of ACOs are clear. Healthcare spending reductions will be driven by attempts to disrupt the high-cost culture associated with volume-based payment. Healthcare quality enhancements will leverage both preventive and reactive tactics to drive performance relative to quality benchmarks. Specifically, enhanced service integration and care coordination will ensure effective management of chronic conditions in low-cost primary care settings, minimizing demand for high-cost acute and ancillary services. If shared savings appropriately offset the revenue loss providers may experience due to efficient service utilization, more patients will receive the appropriate standard of care at a lower price. Although this concept doesn’t seem like rocket science, given the history and complexity in healthcare it’s nothing short of groundbreaking.

Of course, ACOs aren’t necessarily the right choice for every provider. There are inherent risks that will keep the ACO debate whirling around board rooms for some time, not the least of which are the risks associated with change burn-out, inequitable care (i.e. patients within an ACO get a higher standard of care than non-ACO patients), misalignment with organization strategy, revenue reduction, financial penalties tied to low performance, and up-front infrastructure investment. CMS is addressing the latter concern with their Advanced Payment ACO, which provides a proportion of projected shared savings up front for start-up costs.

A small but rapidly growing proportion of healthcare organizations have taken the ACO plunge, with a reported 221 operating across 45 states as of May 2012. These ACO early adopters have varying structures, with more than half being sponsored by hospital systems and just over one-third sponsored by physician groups.1 Specific to the Medicare ACO programs, 116 ACOs had joined the Shared Savings Program as of July 2012 with another cohort joining in January, 2013. An additional 32 ACOs are participating in the CMS Pioneer ACO Program, designed for more experienced and integrated organizations, and 20 are participating in the Advanced Payment ACO. The greater majority of CMS ACOs are physician-led.

If ACOs are successful on a large scale in this country, they will fundamentally alter our health system, underscoring the notion that high-quality care and responsible spending are the right thing to do. As a patient-centered approach, these programs have cost benefits that will eventually filter back to employers and patients, with reductions in health-insurance premiums and subsequent reductions in cost-driven avoidance of care and medication non-compliance.

Are ACOs the answer we’ve been waiting for, or another flavor of the month program waiting to fail? Based on the ethical, economic, and clinical potential, we think it is a significant step in the right direction.


  1. Muhletein, D., et al. Growth and disperson of accountable care organizations: June 2012 update. Leavitt Partners, June 2012. Available online.

Read Part 1: Why Accountable Care Organizations?

Read Part 2: Accountable Care Reflects Paradigm Shift from Volume to Value.

Ally C. Evans is an industrial engineer specializing in process and system improvement in healthcare. Most recently, Ally has driven various initiatives in the Accountable Care arena, focusing on the design and implementation of ACO strategy and tactical interventions. She is a consultant with Freed Associates, a California-based healthcare consulting firm. Their work is to provide sustainable solutions that enable healthcare organization to improve patient care services reduce costs and increase operational efficiency.

HIN Disclaimer: The opinions, representations and statements made within this guest article are those of the author and not of the Healthcare Intelligence Network as a whole. Any copyright remains with the author and any liability with regard to infringement of intellectual property rights remain with them. The company accepts no liability for any errors, omissions or representations.