Pioneer ACO Program Ripe for Improvement, Providers Say

Christopher Cheney, for HealthLeaders Media , June 5, 2014

"The way the Pioneer ACO baseline is calculated, it rewards improvement, not overall quality," says Nyum Gandhi, a Chicago-based partner at Oliver Wyman. "Historically good performers are being penalized."

He says the baseline calculation is a "no-win situation" for CMS. "They're in the business of being the steward of billions of taxpayer dollars. I understand why they did it, but it has caused frustration among providers."

Reforming the Pioneer ACO gainsharing mechanism to make it more lucrative for providers will be necessary to draw more participants to the program, the AHA letter asserts. "The number one way to increase participation in ACO programs is to modify the shared savings determination to ensure that more ACOs are able to receive a bonus—and a larger bonus—so that they can continue to invest in the program," the letter says.

Officials at Newton, MA-based Atrius Health say they have asked CMS to change the gainsharing mechanism on fairness grounds.

"As CMS evaluates the program, we have made recommendations to improve the financial model," the Atrius Health officials said in a media statement. "The model does not [reward] ACOs that were already good stewards of the Medicare dollar prior to the launch of the program. Our first year benchmark was more challenging than other Pioneers in our market since as we already had a long history of providing coordinated and efficient care for these Medicare patients."

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