The Center for Medicare & Medicaid Innovation finally released the much anticipated list of the Pioneer accountable care organizations (ACO) this week. Although industry experts predicted the final list would rack up to 30 ACOs, CMS revealed 32 lucky--and assumingly much deserving--organizations.
So what's the big deal, and how is this announcement any different than the numerous press releases that the regulatory agency puts out? The Pioneer ACOs will lead the charge in changing how providers are paid, moving away from the traditional fee-for-service system to a pay-for-performance approach that rewards quality over quantity. Launching even sooner than the Medicare Shared Savings Program, the Pioneer ACOs are just that, pioneers, and leaders in the healthcare revolution.
However, their ventures into uncharted territories don't come without warnings. Although the 32 ACOs can reap the benefits of the program through Medicare reimbursements, they also assume greater risk. Unlike the Shared Savings Program, starting in year three of the initiative, those organizations that have earned savings during the first two years will be eligible to move to a population-based payment arrangement and full risk arrangement that can continue through an optional fourth and fifth year.
But it's also important to note that Pioneer ACOs are only one model of shared savings. Other providers across the nation are experimenting with care coordination that haven't applied or haven't been accepted into the Medicare Shared Savings Program or the earlier Pioneer ACO Program.
For example, the surprise of many, Mayo Clinic, Cleveland Clinic, Geisinger Health System and Intermountain Healthcare--the most likely poster children for accountable care--all passed on joining the CMS programs. Their reason, like many other providers, was that the rules were too prescriptive and didn't offer enough incentives. That leaves the heavy hitters of healthcare and others seeking alternative routes to collaborative accountable care (not to be confused with the governmental version of accountable care organizations).
Acting CMS Administrator Marilyn Tavenner recognized that "healthcare providers are at different stages in their work to improve care and reduce costs," she said in a Monday press release about the menu of ACO options. (CMS also is testing the Advance Payment ACO Model for physician-owned and rural providers enrolled in the Shared Savings Program.)
Whether through CMS or through individual ventures, the nation certainly will be watching accountable care collaborations and partnerships.
With the first performance period to start on Jan. 1, 2012, the Pioneer ACO is estimated to save Medicare up to $1.1 billion. These selected Pioneer ACOs surely will be in the spotlight:
- Atrius Health Services, Eastern and Central Massachusetts
- Beth Israel Deaconess Physician Organization, Eastern Massachusetts
- Bronx Accountable Healthcare Network, New York
- Dartmouth-Hitchcock ACO, New Hampshire and Eastern Vermont
- Eastern Main Healthcare System, Central, Eastern and Northern Maine
- Mount Auburn Cambridge Independent Practice Association, Eastern Massachusetts
- Partners Healthcare, Eastern Massachusetts
- Renaissance Medical Management Company, Southeastern Pennsylvania
- Steward Health Care System, Eastern Massachusetts
- JSA Medical Group, a division of HealthCare Partners, Orlando, Tampa Bay and surrounding South Florida
- North Texas Specialty Physicians, Tarrant, Johnson and Parker counties in North Texas
- Seton Health Alliance, Center Texas
- Allina Hospitals & Clinics, Minnesota and Western Wisconsin
- Bellin-Thedacare Healthcare Partners, Northeast Wisconsin
- Fairview Health Systems, Minneapolis, Minn., metropolitan area
- Franciscan Health System, Indianapolis and Central Indiana
- Genesys PHO, Southeastern Michigan
- Michigan Pioneer ACO, Southeastern Michigan
- OSF Healthcare System, Central Illinois
- Park Nicollet Health Services, Minneapolis, Minn., metropolitan area
- TriHealth, Inc., Northwest Central Iowa
- University of Michigan, Southeastern Michigan
- Banner Health Network, Phoenix, Arizona metropolitan area
- Brown & Toland Physicians, San Francisco Bay Area, Calif.
- Healthcare Partners Medical Group, Los Angeles and Orange Counties, Calif.
- Healthcare Partners of Nevada, Clark and Ny Counties, Nev.
- Heritage California ACO, Southern, Central and coastal California
- Monarch Healthcare, Orange County, Calif.
- Physician Health Partners, Denver, Colo., metropolitan area
- Presbyterian Healthcare Services - Central New Mexico Pioneer Accountable Care Organization, Central New Mexico
- Primecare Medical Network, Southern California
- Sharp Healthcare System, San Diego County
On behalf of the Fierce team, I'd like to thank all of our readers for following us this year. We won't publish next week, but we'll be back Tuesday, Jan. 3, 2012. I look forward to what is sure to be an exciting 2012 year in healthcare. -Karen (@FierceHealth)