The Centers for Medicare & Medicaid Services (CMS) announced on May 4 that a key pilot
program, the Pioneer Accountable Care Organization (ACO) model,
saved Medicare $384 million over two years (2012-2013). CMS's
independent Office of the Actuary issued a detailed report.
The Pioneer ACO model is the first alternative-payment model
certified by CMS's Actuary Office to cut costs while improving
healthcare quality and is now eligible to be expanded to larger
groups of Medicare beneficiaries. The Pioneer ACO program initially
encountered mixed success, with 13 of the original 32 participants
dropping out of the program or switching to other models after
failing to meet performance targets. Only 13 of the remaining 19
Pioneer ACOs qualified to share in the $280 million savings with
Medicare the first year; just 11 shared the $104 million savings
the second year; and two were required to repay Medicare several
million dollars.
However, a new analysis, published in the Journal of the
American Medical Association (JAMA), was more encouraging. CMS
researchers found that the 600,000 patients in Pioneer ACOs spent,
on average, $36 less per month in 2012 and $11 less per month in
2013 than comparable non-affiliated patients. The JAMA analysis
also found that Pioneer patients had fewer hospitalizations; used
fewer tests, procedures and imaging services; and reported more
timely care and better communication with clinicians than the
comparison group.
Some experts say that more options and incentives for health
systems will be needed to meet the federal government's
ambitious goals of tying 30% of traditional, or
fee-for-service, Medicare payments to quality or value through
alternative payment models, such as ACOs or bundled payment
arrangements, by the end of 2016, and tying 50% of payments to
these models by the end of 2018.
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