The Pioneer ACOs Have Arrived—Things Are Going to Start Happening Now
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Perhaps one of the most memorable scenes from Steve Martin’s classic movie The Jerk was when the new phonebooks arrived. Navin R. Johnson (Martin) dances and screams, “I'm somebody now! I'm in print! Things are going to start happening to me now.” For the 32 organizations listed in the Pioneer ACO announcement on December 19, 2011, they are definitely somebodies now. And for the rest of us, it’s time to really start paying attention.
Offered through CMS’s Innovation Center, the Pioneer ACO program provided an alternative path for organizations to develop ACOs after the proposed rule for Medicare’s initial ACO effort (the Shared Savings Program) was effectively declared unfit for consumption by hospitals, health systems, and the industry in general.
The 32 selected organizations (whittled down from more than 80 applicants) represent an interesting cross-section of the primary and acute care providers. While there are a few rural providers, the balance are academic medical centers, community hospital networks, and physician organizations in major metropolitan/urban markets. It is interesting to note the heavy concentration of recipients in four states—Minnesota, Michigan, Massachusetts, and California.
For providers located in a Pioneer market—especially post-acute, skilled nursing, and home health organizations—the program offers a lot of flexibility for the Pioneer recipients to test different approaches to patient care or even waive some Medicare rules. That means changes are either already underway in your market or coming soon.
For instance, the program requires Pioneer ACOs to enter into other outcomes-based contracts with other purchasers. We’re hearing from many providers who have already been quietly approached by Pioneer awardees to be part of a preferred provider network. In one market, a Pioneer-affiliated community hospital has selected 14 SNFs for their network—from a pool of more than 70 current providers. Other organizations have also confirmed that they expect to be working with smaller, more select groups of post-acute and skilled nursing facilities within the next 12 months. The CEO at Atrius Health, Gene Lindsay, has openly said, “We will be focusing a lot of our attention on post-acute care.”
And while many providers have scoffed at the notion of preferred networks and the pivotal role of “patient choice,” the Pioneer ACOs are in a position to potentially share a portion of savings with Medicare beneficiaries themselves—similar to the Acute Care Episode demonstration project in the southwestern United States. That facet of the demonstration resulted in considerable changes in both market share and patient behavior. Without question, the Pioneer ACO model includes strict beneficiary provisions regarding a patient’s ability to receive care from any Medicare provider they choose. But if you can offer a patient both improved health (in the form a measurable outcome) and the opportunity for some kind of financial reward for participation, will they choose to go somewhere else? What would you do?