Two years in, Pioneer ACOs save $384M

The Pioneer Accountable Care Model has generated more than $384 million in savings to Medicare during its first two years, according to an independent evaluation report released by the Department of Health and Human Services (HHS).

Additionally, the independent Office of the Actuary in the Centers for Medicare & Medicaid Services (CMS) has certified that this patient care model is the first to meet the stringent criteria for expansion to a larger population of Medicare beneficiaries.

The savings equal an average of approximately $300 per participating beneficiary per year. The Actuary’s certification that expansion of Pioneer ACOs would reduce net Medicare spending, coupled with HHS Secretary Sylvia Mathews Burwell’s determination that expansion would maintain or improve patient care without limiting coverage or benefits, means that HHS will consider ways to scale the Pioneer ACO Model into other Medicare programs.

“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 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.”

The Pioneer ACO Model is serving more than 600,000 Medicare beneficiaries. According to the report, these beneficiaries report more timely care and better communication with their providers, use inpatient hospital services less and have fewer tests and procedures and have more follow-up visits from their providers after hospital discharge.

“This success demonstrates that CMS can design and test innovative payment and service delivery models that produce better outcomes for the Medicare program and beneficiaries,” added Patrick Conway, MD, the acting principal deputy administrator of CMS. “This gives CMS greater confidence in scaling elements of the model to benefit people across the nation, and we are working to determine the best strategies for embedding the lessons we have already learned from the Pioneer Model into permanent Medicare programs and our nation’s health system.”