By Fred Segal
On December 19, 2011, CMS announced the 32 organizations selected by the CMS Innovation Center to participate as a Pioneer ACO. These ACOs have entered into contracts that commenced on January 1, 2012. The Pioneer ACOs were chosen from a lengthy and competitive application process which began in May 2011. Please click here for an extensive list of the 32 participating organizations.
The CMSInnovationCenter was created by the Patient Protection and Affordable Care Act of 2010 (PPACA). According to PPACA, the purpose of the Center is “to test innovative payment and service delivery models to reduce program expenditures…” The Pioneer ACO Model is an example of one of these innovative models. The Pioneer Model is designed for health care organizations and providers that have experience in coordinating patient centered care across care settings and operating in ACO like arrangements.
In the first two performance years, the Pioneer Model will test a shared savings arrangement with higher levels of risk and reward than the CMS Shared Savings Program. Beginning in the third performance year, the participating organizations that reach a minimum amount of savings in years one and two will be eligible to receive population based payments on a per month per payment amount. These full risk arrangements can continue through optional years four and five. The participating organizations will generally be responsible for the care of at least 15,000 beneficiaries. This is significantly higher than the Shared Savings Program in which the minimum number of beneficiaries for participating ACOs is 5,000. The patients will be aligned to the participating organizations prospectively.