Half the Pioneer ACOs have left the program, some gearing up for Next Generation ACO program

By Jonah Comstock
08:01 am
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JONAH_COMSTOCK_HEADSHOTA growing number of participants in CMS's Pioneer ACO program are dropping out of the program prior to the launch of the Next Generation ACO program, which will allow providers to be reimbursed for using more kinds of technology. According to Modern Healthcare, at least half of the original 32 Pioneer ACOs, which joined the program in 2012, have now dropped out of the program.

The latest two to leave are two of the five Massachusetts-based provider groups in the program: Mount Auburn Cambridge Independent Practice Association and the Steward Health Care System. Three other Massachusetts organizations, Partners HealthCare, Beth Israel Deaconess Care Organization, and Atrius Health, still remain, the Boston Globe reports.

A representative for Mount Auburn told the Globe that they had saved $14 million over three years in the Pioneer program, but expected to lose money because of rule changes to the Pioneer program that would have reduced its budget for patient care. They're still deciding whether to join the Next Generation pilot, but hope its rules will be more favorable.

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According to Modern Healthcare, Steward is preparing to join the Next Generation program, which necessitates their dropping out of the last year of the Pioneer program, but they won't make a final decision until they see how their spending targets are set. They've saved $30 million over the last three years, and is on track to save again this year, but they feel they can do better with the new program, which is higher-risk but also higher-reward.

There are a number of differences between the Pioneer program and the Next Gen program, but one notable one is that for Next Generation ACOs, CMS will waive a prohibition on covering at-home telemedicine or in-hospital telemedicine in urban areas. The prohibition is still in force for Pioneer ACOs.

“Even though they’re not technically in the fee-for-service world, they still have this prohibition, which is just crazy,” American Telemedicine Association CEO Jonathan Linkous told MobiHealthNews back in March, when the Next Generation program was first announced. “The law does allow the secretary to waive that requirement, they can waive that for ACOs to allow them to use telemedicine, but the secretary’s never chosen to do this even though we’ve been pleading on our knees trying to get them to do this.”

It's harsh to say that Pioneer ACOs have failed -- they have produced $304 million in savings in three years and 55 percent of participants managed to reduce costs enough to qualify for bonus payments. But it's clear that some Pioneer ACOs are eager to move on to the next iteration of CMS shared savings, as the federal government figures out exactly where the sweet spot is for value-based incentives.

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