The Pioneer ACO Model was designed and sponsored by CMS under provisions of the Patient Protection and Affordable Care Act to provide Medicare beneficiaries with high-quality care while reducing expenditures through better care coordination. To be successful in the first year, participating organizations were required to report on 33 quality and patient satisfaction measures as well as lower costs to the Medicare program.
In all, a majority of participating health systems indicated improvement in care delivery and promise in the area of cost savings, including the ability to participate in those cost savings, according to the CMS Innovation Center's highlights from the first performance year of the Pioneer ACO model. Savings totaled $140 million, $76 million of which will be returned to the Pioneer ACOs as their portion of the shared savings. A net savings of $33 million will be returned to the Medicare trust funds.
CMS' report notes that all 32 participating health systems were able to show improved patient care related to quality and patient satisfaction benchmarks, specifically with respect to cancer screenings and controlling blood pressure.
However, only 18 of the 32 health systems lowered costs for the Medicare patients they treated and only 13 systems saved enough to share savings with the Medicare program. Two systems cost Medicare more and reportedly may owe $4 million back to the program. Further, nine Pioneer ACOs will be leaving the program.
The Center's background and lessons learned
More than 60 percent of the Medicare patients attributed to Montefiore's ACO are under the care of private practice physicians in community offices, with the remainder under care of Montefiore's employed physicians. Approximately 10 percent of patients with complex, chronic illness received intensive care management services from Montefiore. And all ACO patients have access to Montefiore's innovative care coordination programs, if needed.
Montefiore Medical Center actually functioned as an accountable care organization long before the term was coined, according to Chung. Nearly two decades ago, Montefiore began the process of building an integrated delivery system with acute care hospitals; primary care and home care programs; investments in what is now an IT infrastructure that supports coordination of care across locations; and a payment arrangement with health plans that included financial accountability and performance incentives.
