CMS to accept applications for Pioneer ACOs

The Centers for Medicare & Medicaid Services (CMS) will begin accepting applications for its accountable care organization (ACO) test model. According to a notice filed May 17, which will be published in the Federal Register on May 20, the CMS will request applications for organizations to participate in the Pioneer Accountable Care Organization Model for a five- to six-year period, starting in the third or fourth quarter of 2011.

It will end in December 2016, and the duration includes two optional one-year periods, according to CMS.

The Pioneer ACO Model is designed for healthcare organizations and providers that already have experience coordinating care for patients across care settings. It will allow 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,” CMS stated.

The Pioneer ACO Model intends to align payor and provider incentives to improve quality and health outcomes for patients across the ACO, and to achieve cost savings for Medicare, employers and patients. Using the Pioneer ACO Model, the Innovation Center intends to:

• Test a more rapid transition for providers from volume based fee-for-service payments to payment for coordination and outcomes.
• Promote a diversity of successful ACOs, including physician-led ACOs and those serving indigent or rural populations.

 
The model will test the effectiveness of a combination of payment arrangements that place a group of providers at joint risk for quality performance and financial performance for the majority of their patients and revenues (including non-Medicare patients and revenues), CMS stated. The payment arrangements will require participants to transition from fee-for-service to population-based payment by the third performance year.

CMS said it expects to partner with approximately 30 organizations in the Pioneer model, with a minimum of 15,000 Medicare beneficiaries each (or 5,000 for rural ACOs). Applications will be prioritized based on the strength of their care improvement plans, leadership and commitment to outcomes-based contracts with non-Medicare purchasers, according to CMS.

Final selection will be based on the strength of the application and on interviews, and other factors, to promote representation of diverse geographic areas, types of organizations and types of Medicare populations served, CMS stated.

Interested organizations must submit a nonbinding letter of intent by June 10, as described on the CMS Innovation Center website. Applications must be submitted by mail and postmarked no later than July 18.

Advance payment
In addition, CMS, through the Innovation Center, is seeking public comment on a pre-payment initiative to test whether pre-paying a portion of future shared savings could increase participation.

Under the Advance Payment Initiative for ACOs entering the Medicare Shared Savings Program, eligible organizations could receive an advance on the shared savings they are expected to earn as a monthly payment for each aligned Medicare beneficiary. ACOs would need to provide a plan for using these funds to build care coordination capabilities, and meet other organizational criteria. Advance payments would be recouped through the ACOs’ earned shared savings, according to CMS.

Comments can be submitted here and should be received by June 17.

Learning sessions

The Innovation Center will offer free Accelerated Development Learning Sessions to teach providers interested in becoming ACOs what steps they can take to improve care delivery and how to develop an action plan for moving toward providing better coordinated care.

The first session is scheduled for June 20-22 in Minneapolis. The plenary session will be available to all interested organizations through a webcast and all materials from the sessions will be publicly available.