CMS announces first year Pioneer results, ACOs leaving program

The Centers for Medicare & Medicaid Services (CMS) announced positive and promising results from the first performance year of the Pioneer Accountable Care Organization (ACO) Model, including higher quality care and lower Medicare expenditures. But, seven of the ACOs will switch to a different ACO model and two will drop out entirely.

“These results show that successful Pioneer ACOs have reduced costs for Medicare and improved the quality of care for their patients,” said CMS Administrator Marilyn Tavenner. “The Affordable Care Act has given us a wide range of tools to realign payment incentives in Medicare and Medicaid, and these efforts are already paying off.”

Costs for the more than 669,000 beneficiaries aligned to Pioneer ACOs grew by only 0.3 percent in 2012 where as costs for similar beneficiaries grew by 0.8 percent in the same period. Thirteen out of 32 Pioneer ACOs produced shared savings with CMS, generating a gross savings of $87.6 million in 2012 and saving nearly $33 million to the Medicare Trust Funds. Pioneer ACOs earned over $76 million by providing coordinated, quality care. Only two Pioneer ACOs had shared losses totaling approximately $4 million. Program savings were driven, in part, by reductions that Pioneer ACOs generated in hospital admissions and readmissions.   

All 32 Pioneer ACOs successfully reported quality measures and achieved the maximum reporting rate for the first performance year, with all earning incentive payments for their reporting accomplishments. Overall, Pioneer ACOs performed better than published rates in fee-for-service Medicare for all 15 clinical quality measures for which comparable data are available. (Seven measures had no comparable data in the published literature.) Examples of the high quality care provided by the Pioneer ACOs include:

• Readmissions: 25 Pioneer ACOs generated lower risk-adjusted readmission rates for their aligned beneficiaries than the benchmark rate for all Medicare fee-for-service beneficiaries.

• Blood Pressure Control: Pioneer ACOs performed better on clinical quality measures that assess hypertension control for patients. The median rate among Pioneer ACOs on blood pressure control among beneficiaries with diabetes was 68 percent compared to the comparison value of 55 percent as measured in adult diabetic population in 10 managed care plans across seven states from 2000 to 2001.  

• Cholesterol Control for Diabetes Patients: Pioneer ACOs performed better on clinical quality measures that assess low density lipoprotein (LDL) control for patients with diabetes. The median rate among Pioneer ACOs for LDL control among beneficiaries with diabetes was 57 percent compared to 48 percent in an adult diabetic population in 10 managed care plans across seven states from 2000 to 2001. 

Pioneer ACOs have taken tangible steps to improve care while lowering costs and evidenced by the following examples:

• Banner Health Network dispatches hospital-trained nurses to patients’ homes to do whatever the patient needs—manage prescription drugs, take blood-sugar readings, teach healthy eating habits or even arrange delivery of a motorized wheelchair. 

• Monarch HealthCare ACO offers care coordination, a service for beneficiaries who need assistance with coordinating the medications and many care visits associated with having multiple diagnoses. In one case, a Monarch ACO patient was given conflicting medication advice from her OB/GYN and primary care physician. A care coordination pharmacist was able to review her records, walk through options with her, and outline the timing, benefits and likely side effects of each regimen. 

In addition, Pioneer ACOs were rated higher by ACO beneficiaries on all four patient experience measures relative to the 2011 Medicare fee-for-service results.

Seven Pioneer ACOs that did not produce savings have notified CMS that they intend to apply to another ACO model, the Medicare Shared Savings Program. Two Pioneer ACOs have indicated to CMS their intent to leave the program. Overall, more than 250 organizations participate in the Pioneer ACO Model and the Medicare Shared Savings Program, serving 4 million Medicare beneficiaries, and more ACOs can join the Shared Savings Program each January.

The Pioneer ACO Model, as created by the Affordable Care Act, encourages providers and caregivers to deliver more coordinated care for Medicare beneficiaries. This model, launched by the CMS Innovation Center, is part of the Affordable Care Act’s efforts to realign payment incentives, promoting high quality, efficient care for Medicare beneficiaries. ACOs, including the Pioneer ACO Model and the Medicare Shared Savings Program, are one way CMS is providing options to providers looking to better coordinate care for patients and use healthcare dollars more wisely.