The following is an article from ACO Insights. Visit www.acoinsights.com for the latest on accountable care.
According to Kaiser Health News, some of the leading health systems in the nation have declined to participate in the Pioneer accountable care program announced this summer by the Centers for Medicare & Medicaid Services (CMS). The Mayo Clinic, the Cleveland Clinic, Geisinger Health System and Intermountain Healthcare were repeatedly touted as models for a new health care delivery system, but have declined the Pioneer program, Kaiser Health News reported.
Reviewing the rules
The Pioneer option was introduced following the release of CMS’ proposed ACO rules in March, which were met with a cool reception by many providers and health systems who said the risk-reward wasn’t worth it, not to mention the investment needed to develop a new delivery model with physician alignment and EMR technology.
“It has a number of very specific administrative hurdles that are probably overly detailed,” Thomas Graf, MD, Chairman, Community Practice Service line for Geisinger Health System, said during the summer. “The protection that was put in place for CMS and for some of the government stakeholders creates a business model that probably is not going to be widely embraced. The risk-return ratio is probably beyond what most organizations are comfortable doing right out of the gate. Certainly the quality measures are very important, but again, that program seems to be somewhat aggressive in its timeline.”
In May, CMS introduced three new Affordable Care Act initiatives, including the Pioneer ACO Model, which according to CMS was designed for “advanced organizations ready to participate in shared savings.” But some of those organizations, including Mayo, Cleveland and Geisinger, declined to participate, instead waiting to see what CMS’ final rules on ACOs will be. Geisinger and some of the other organizations decided to remain in the Physician Group Practice Demonstration instead for another two years.
Those who are in
Although CMS hasn’t released how many organizations have applied, Kaiser Health News reported that the Advisory Board Company, a hospital consulting firm, estimates that between 30 and 50 organizations have applied for the Pioneer program. A partial list from Kaiser included Tucson Medical Center in Arizona; Banner Health (multiple states); Mountain States Health Alliance (multiple states); Minnesota-based Fairview Health Services; New Jersey-based Hackensack University Medical Center; Texas Health Resources; and Michigan-based Henry Ford Health System.
“Fairview Health Services submitted an application for the Pioneer ACO,” Fairview said in a released statement. “Fairview is changing care delivery models and seeking payment models that recognize the value we create for patients and payers. The Pioneer presents an opportunity for us to work with Medicare to change the payment model.”
“Regardless of how the federal government chooses to define it, the accountable care model is still the future of health care delivery, and the best option for patients, payers and providers,” said Dennis Vonderfecht, president and CEO of Mountain States Health Alliance, ISHN’s primary stakeholder. “The triple-aim of the ACO model – improving health, reducing cost and enhancing the patient experience – is a set of values MSHA has embraced for some time. The formation of an ACO allows us to put a structure to that commitment, and to partner on that mission with other providers and community stakeholders for the benefit of all patients in this region.”