Despite promising results, Pioneer ACO program loses two more organizations

Editor's note: An earlier version of this story incorrectly implied Steward exited the Pioneer program due to financial problems. The wording has been clarified; we apologize for the error.

Participants in Medicare's Pioneer Accountable Care Organization (ACO) program continue to dwindle, with two more announcing their departures even as the research finds the program improves care quality.

Massachusetts' Steward Health Care System and Mount Auburn Hospital will both leave the program, according to the Boston Globe, but plan to join Medicare's Next Generation ACO program. While Mount Auburn saved some $14 million during its three years in the program, new rules cutting its patient care budget were expected to result in losses. Steward's ACO saved even more, about $30 million, over the same period, and will switch to the Next Generation program because it expects to perform better financially under the model despite steeper financial risk, according to the article.

"In a lot of ways, [the Next Generation program] is Pioneer ACO on steroids," Sanjay Shetty, M.D., president of the Steward physicians network, told the Globe.

Both the exits and the plans to join the newer model echo Dartmouth-Hitchcock Health System, which was one of the program's top performers on care quality, dropped from the initiative. The organization said it wasn't saving enough to justify its continued participation, FierceHealthcare previously reported. Dartmouth-Hitchcock has expressed similar hopes of joining the Next Generation program.

Meanwhile, data from the Centers for Medicare & Medicaid Services (CMS) indicate both the Pioneer and Medicare Shared Savings programs show that while many ACOs in both programs are improving both care quality and savings, it's difficult to find a strategy that balances the two, according to a Health Affairs blog post. The data also paint a clearer picture of common features of the more successful ACOs, according to the post, with those ACOs that are physician-based and those with federally qualified health centers or rural health clinics performing particularly well. Smaller ACOs appear to be associated with better outcomes, according to the post: ACOs with fewer than 6,500 attributed patients saved an average of 1.5 percent, compared to only 0.5 percent for larger ACOs.

The 20 Pioneer ACOs and 333 MSSP ACOs collectively generated more than $400 million in net savings last year as well as significantly improving quality of care, with a total of 97 keeping spending far below benchmarks, according to CMS. Within the Pioneer program, ACOs improved on 28 of 33 quality measures, improving an average of 3.6 percent across quality measures compared to the year before. ACOs made particularly promising strides in medication reconciliation and screening for clinical depression and follow-up planning.

To learn more:
- read the Globe article
- here's the CMS fact sheet
- read the blog post