HHS will expand Pioneer ACO program

The Centers for Medicare & Medicaid Services' Pioneer Accountable Care Organization (ACO) program saved nearly $400 million in two years, qualifying it for an expansion, the Department of Health and Human Services announced this week.

An independent evaluation commissioned by CMS found the Pioneer program, despite the fact many of its original participants exited the program, generated more than $384 million in savings its first two years, or an average of $300 per beneficiary, at no cost to care quality. In addition to the savings, the data indicates that on average Pioneer ACO beneficiaries:

  • Have lower utilization rates for tests, procedures and inpatient hospital care
  • Receive more post-discharge follow-up visits from their providers
  • Report they received more timely care and better patient-doctor communication

"This is a crucial milestone in our efforts to build a healthcare system that delivers better care, spends our healthcare dollars more wisely and results in healthier people," said HHS Secretary Sylvia Mathews Burwell. "The Affordable Care Act gave us powerful new tools to test better ways to improve patient care and keep communities healthier. The Pioneer ACO Model has demonstrated that patients can get high quality and coordinated care at the right time, and we can generate savings for Medicare and the healthcare system at large."

In light of the results, as well as Burwell's determination that expansion of the Pioneer program would mean equal or better care quality without restricting benefits or coverage, HHS will investigate methods of adapting the Pioneer model to other Medicare programs, according to the announcement.

The news from HHS follows research last week that found Pioneer ACOs saw smaller spending increases compared to general Medicare fee-for-service beneficiaries in the program's second year, as well as similarly better scores on patient care, inpatient utilization and clinician communication. However, researchers wrote the next five years will be the program's real test.

To learn more:
- read the announcement