Nine of 33 Pioneer ACOs Exit; Seven Will Migrate to MSSP

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While quality and cost data improved overall for the 33 Pioneer ACOs in their first year of operation, CMS announced that nine of them intend to exit the Pioneer ACO program. Two of the nine will leave the program entirely and seven will migrate to the Medicare Shared Savings Program (MSSP), which does not require the initial assumption of risk. None of the nine produced shared savings.

As a group, the ACOs managed to hold cost increases to an average .3% for the 669,000 beneficiaries receiving care from the 33 organizations, compared to an increase in cost of .8% for similar beneficiaries, the government reported.

Thirteen of the 33 Pioneer ACOs will share $76 million of the $87.6 million in shared savings they produced. Two of the participants had shared losses of about $4 million. One of the Pioneer ACOs that had losses, the non-profit Atrius Health in Eastern Massachusetts, does not plan to leave the program.

Emily Brower, executive director of the Atrius ACO, told the Wall Street Journal that one difficulty the organization faced was a historically low cost-per-patient. “We didn’t have as much low-hanging fruit,” she told the newspaper.

The Pioneer ACOs appear to have outperformed their fee-for-service peers on the quality front, at least as defined by the 15 Pioneer ACO quality measures. All 33 ACOs successfully reported on the 15 measures, outperforming traditional health-care organizations on the 8 measures for which published data is available.

For instance, 25 of the 32 Pioneer ACOs generated lower readmission rates for their beneficiaries than the benchmark for all Medicare fee-for-service beneficiaries. Also, the Pioneer organizations achieved a 68% rate on blood-pressure control among beneficiaries with diabetes compared to the benchmark rate of 55% (as reported by 10 managed care plans across seven states in 2000 to 2001).

Two of those nine exiting the program include California providers HealthCare Partners ACO California and PrimeCare, according to an article in California Healthline. HealthCare Partners, recently acquired by dialysis giant DaVita, intends to move into the MSSP.

Another California Pioneer ACO, Brown & Toland Physicians, reported savings of $10.6 million in the first year, attributed to its focus on transition-to-care.

According to the Health Affairs Blog, an estimated 4 million beneficiaries are receiving coverage through Medicare ACO programs and another 8 to 14 million beneficiaries are in private sector ACOs. Also, 14 states are developing accountable care models in Medicaid and CHIP.

CMS Press Release