Eighteen months ago, 32 accountable care organizations took a bold step toward ACO development, enlisting in the Centers for Medicare and Medicaid Services' Pioneer ACO program. By taking part in this two-year program, these 32 organizations immediately became models of how the quality-based payment structures sweeping through the healthcare sector could produce better outcomes for patients.
The number of ACOs swelled from 116 one year after the launch of the Pioneer ACO program to 250 this spring. The only sign of trouble for the Pioneer ACOs occurred last February, when some organizations challenged the benchmarks set by CMS.
And now, the ranks of those original 32 ACOs could be thinning, as up to nine of these pioneers could soon leave the program, with at least four ACOs opting instead for the CMS' Medicare Shared Savings Program—a lower-risk initiative with more aggressive quality targets. ACOs have until July 31 to make their decision.
"We're encouraged that these organizations want to continue in programs that promote better care at lower costs," said CMS spokesman Alper Ozinal. "We fully anticipated that as these programs get up and running, some organizations would shift between models."
Given Ozinal's comments, it's important to note that the CMS considered the Pioneer ACO program to be a pilot initiative. Even back when the Pioneer ACO program launched, the CMS noted the differences between that initiative and the Shared Savings Program, including:
- Higher levels of savings and risk for Pioneer ACOs.
- By the end of the second year of the program, Pioneer ACOs are expected to fully commit to outcomes-based payment model.
Whichever path toward ACO development an organization chooses, a healthcare consulting firm will walk it through the path to new payment models.