Chasing Unicorns? 32 Health Systems Don’t Believe So

As an author of a book focused on planning for Accountable Care Organizations, I’ve heard from all too many providers and consultants who believe the concept will never take off.

Although I remain cautiously optimistic about this new care delivery model, I am very much looking forward to the results of the Pioneer ACO program.

As you may be aware, the Pioneer ACO program is the latest initiative from CMS’s Innovation Center. The goal is to assess the impact of different payment mechanisms within organizations that have already proven they can accept risk and act as an ACO. More to the point, the goal is to provide better care to Medicare beneficiaries and reduce Medicare’s costs.

The participants have been selected and the program has begun as of January 1 of this year. CMS was looking for up to 30 provider organizations to start the program and they ended up selecting 32 (out of more than 80 applicants) from 18 states. They estimate that, if successful, the program will save $1.1 billion over the next five years.

The first two years of the Pioneer ACO Model will test the shared savings payment policy with generally higher levels of shared savings and risk for Pioneer ACOs than the current levels in the Medicare Shared Savings Program.

In year three of the program, participating ACOs that have shown a specified level of savings over the first two years will be eligible to move a substantial portion of their payments to a population-based model, which is designed to financially reward patient care when specific quality-of-care benchmarks have been met.

So, why am I excited? Because it won’t be too long now before CMS answers the question many have been asking: “Are we chasing unicorns?” Until then, we only know that more than 80 provider organizations don’t believe so, and 32 have been charged with answering the question once and for all.