[NYAPRS Enews] HHS Approves 32 Pioneer Accountable Care Organizations

[Harvey Rosenthal]

Affordable Care Act Helps 32 Health Systems Improve Care For Patients,
Saving Up To $1.1 Billion

Leading health care providers will be Pioneer Accountable Care
Organizations

 

Thirty-two leading health care organizations from across the country
will participate in a new Pioneer Accountable Care Organizations (ACOs)
initiative made possible by the Affordable Care Act, HHS Secretary
Kathleen Sebelius announced today.  The Pioneer ACO initiative will
encourage primary care doctors, specialists, hospitals and other
caregivers to provide better, more coordinated care for people with
Medicare and could save up to $1.1 billion over five years.

Under this initiative, operated by the Centers for Medicare & Medicaid
Services (CMS) Innovation Center (Innovation Center), Medicare will
reward groups of health care providers that have formed ACOs based on
how well they are able to both improve the health of their Medicare
patients and lower their health care costs.
"Pioneer ACOs are leaders in our work to provide better care and reduce
health care costs," said Secretary Sebelius.  "We are excited that so
many innovative systems are participating in this exciting initiative -
and there are many other ways that health care providers can get
involved and help improve care for patients."

The Pioneer ACO initiative is just one of a menu of options for
providers looking to better coordinate care for patients and use health
care dollars more wisely.  The Pioneer ACO model is designed
specifically for groups of providers with experience working together to
coordinate care for patients.  The Medicare Shared Savings Program and
the Advance Payment ACO Model, both announced in October 2011
<http://www.cms.gov/apps/media/press/release.asp?Counter=4132&intNumPerP
age=30&checkDate=&checkKey=&srchType=1&numDays=3500&srchOpt=0&srchData=&
keywordType=All&chkNewsType=1%2C+2%2C+3%2C+4%2C+5&intPage=&showAll=&pYea
r=&year=&desc=false&cboOrder=date> , are also ACO options for providers.
More information about the full menu of options for providers and how to
apply to participate is available here
<http://www.cms.gov/ACO/Downloads/ACO-Menu-Of-Options.pdf> .

"We know that health care providers are at different stages in their
work to improve care and reduce costs," said Marilyn Tavenner, acting
Administrator of CMS.  "That's why we've developed a menu of options for
Medicare to meet doctors, hospitals, and other healthcare providers
where they are, and begin the conversation of how to enhance the care
they are offering to people with Medicare."

The 32 Pioneer ACOs underwent a rigorous competitive selection process
by the Innovation Center, including extensive review of applications and
in-person interviews.

The initiative will test the effectiveness of several innovative payment
models and how they can help experienced organizations to provide better
care for beneficiaries, work in coordination with private payers, and
reduce Medicare cost growth.  These payment models will allow
organizations that are successful in achieving better care and lower
cost growth to move away from a payment system based on volume under the
fee-for-service model, towards one where the ACO is paid based on the
value of care it provides.

The Pioneer ACO model requires ACOs to engage other payers in similar
efforts to reward health care providers that deliver high-quality care.
The Pioneer ACO model also includes strict beneficiary protections,
including the ability for patients to seek care from any Medicare
provider they wish.

Selected Pioneer ACOs include physician-led organizations and health
systems, urban and rural organizations, and organizations in various
geographic regions of the country, representing 18 States and the
opportunity to improve care for about 860,000 Medicare beneficiaries.

The first performance period of the Pioneer ACO Model will begin
January, 1st 2012.

For the final list of participating Pioneer ACOs and more information
about the Pioneer ACO Model, a fact sheet is posted at
http://www.cms.gov/apps/media/fact_sheets.asp or you can visit:
http://innovations.cms.gov/initiatives/aco/pioneer

The Pioneer ACO Model is one of several initiatives underway at CMS
designed to support the formation of ACOs.  For more information, visit
www.cms.gov/aco.

For more information about the CMS Innovation Center, visit
innovations.cms.gov <http://www.innovations.cms.gov/> .

==========

Pioneer Accountable Care Organization Model:

General Fact Sheet

The Pioneer ACO Model is a CMS Innovation Center initiative designed to
support organizations with experience operating as Accountable Care
Organizations (ACOs) or in similar arrangements in providing more
coordinated care to beneficiaries at a lower cost to Medicare.  The
Pioneer ACO Model will test the impact of different payment arrangements
in helping these organizations achieve the goals of providing better
care to patients, and reducing Medicare costs. 

 

Accountable Care Organizations 

Accountable Care Organizations (ACOs) are one way CMS is working to
ensure better health care, better health, and lower growth in
expenditures through continuous improvement. 

The Medicare Shared Savings Program provides incentives for ACOs that
meet standards for quality performance and reduce cost while putting
patients first. Established by the Affordable Care Act, CMS published
final rules for the Shared Savings Program on November 2, 2011. 

More information is available at www.cms.gov/sharedsavingsprogram.  

Working in concert with the Shared Savings Program, the Innovation
Center is testing an alternative ACO model, the Pioneer ACO Model. The
Innovation Center is also testing the Advance Payment ACO Model, which
will provide additional support to physician-owned and rural providers
participating in the Shared Savings Program who would benefit from
additional start-up resources to build the necessary infrastructure,
such as new staff or information technology systems.2

More information on all of these initiatives is available on the
Innovation Center website at www.innovations.cms.gov. 

 

The Pioneer ACO Model and Selected Organizations

The Pioneer ACO Model was designed specifically for organizations with
experience offering coordinated, patient-centered care, and operating in
ACO-like arrangements.  The selected organizations were chosen for their
significant experience offering this type of quality care to their
patients, along with other criteria listed in the Request for
Applications (RFA) document available at www.innovations.cms.gov.  These
organizations were selected through an open and competitive process from
a large applicant pool that included many qualified organizations.  

The 32 organizations participating in the Pioneer ACO Model:

Organization Service Area

1. Allina Hospitals & Clinics Minnesota and Western Wisconsin

2. Atrius Health Services Eastern and Central Massachusetts 

3. Banner Health Network Phoenix, Arizona Metropolitan Area (Maricopa
and Pinal Counties)

4. Bellin-Thedacare Healthcare Partners Northeast Wisconsin

5. Beth Israel Deaconess Physician  Eastern Massachusetts

6. Bronx Accountable Healthcare Network (BAHN) New York City (the Bronx)
and lower  Westchester County, NY

7. Brown & Toland Physicians San Francisco Bay Area, CA 

8. Dartmouth-Hitchcock ACO New Hampshire and Eastern Vermont

9. Eastern Maine Healthcare System Central, Eastern, and Northern Maine3

10. Fairview Health Systems Minneapolis, MN Metropolitan Area

11. Franciscan Health System Indianapolis and Central Indiana

12. Genesys PHO Southeastern Michigan

13. Healthcare Partners Medical Group Los Angeles and Orange Counties,
CA

14. Healthcare Partners of Nevada Clark and Nye Counties, NV

15. Heritage California ACO Southern, Central, and Costal California

16. JSA Medical Group, a division of HealthCare Partners Orlando, Tampa
Bay, and surrounding South Florida

17. Michigan Pioneer ACO Southeastern Michigan

18. Monarch Healthcare Orange County, CA

19. Mount Auburn Cambridge Independent Practice Association (MACIPA)
Eastern Massachusetts

20. North Texas Specialty Physicians Tarrant, Johnson and Parker
counties in North Texas

21. OSF Healthcare System Central Illinois

22. Park Nicollet Health Services Minneapolis, MN Metropolitan Area

23. Partners Healthcare Eastern Massachusetts

24. Physician Health Partners Denver, CO Metropolitan Area4

25. Presbyterian Healthcare Services -Central New Mexico Pioneer
Accountable Care Organization Central New Mexico

26. Primecare Medical Network Southern California (San Bernardino and
Riverside Counties)

27. Renaissance Medical Management Company Southeastern Pennsylvania

28. Seton Health Alliance Central Texas (11 county area including
Austin)

29. Sharp Healthcare System San Diego County

30. Steward Health Care System Eastern Massachusetts

31. TriHealth, Inc. Northwest Central Iowa

32. University of Michigan Southeastern Michigan

 

The Innovation Center 

The Innovation Center was created by the Affordable Care Act to test new
models of health care delivery and payment. The Center also offers
technical support to providers to improve the coordination of care and
share lessons learned and best practices throughout the health care
system. It is committed to refining the Medicare, Medicaid and CHIP
programs to deliver better care for individuals, better health for
populations, and lower growth in expenditures.

 

Payment Arrangement and Beneficiary Alignment

The first performance period begins in January 1st, 2012.  In the first
two performance years, the Pioneer Model tests a shared savings and
shared losses payment arrangement with higher levels of reward and risk
than in the Shared Savings Program. These shared savings would be
determined through comparisons against an ACO's benchmark, which is
based on previous CMS expenditures for the group of patients aligned to
the Pioneer ACO

In year three of the program, those Pioneer ACOs that have shown savings
over the first two years will be eligible to move to a population-based
payment model. Population-based payment is a per-beneficiary per month
payment amount intended to replace some or all of the ACO's
feefor-service (FFS) payments with a prospective monthly payment. 

Additionally, during the application process, organizations were invited
to propose alternative payment arrangements.  CMS established two
alternatives to the core payment arrangement discussed above based on
this input.  Both of these alternatives follow a shared savings model in


years one and two, and provide an option for a partial population based
payment that removes limits on rewards and risks in year three.   These
arrangements will allow Pioneer ACOs more flexibility in the speed at
which they assume financial risk.  

Under the Pioneer ACO Model, CMS will prospectively align beneficiaries
to ACOs, allowing care providers to know at the beginning of a
performance period for which patients' cost and quality they will be
held accountable. 

 

Beneficiary Protections and Quality Measures 

Providing the beneficiary with a better care experience is one of the
central focuses of the Pioneer ACO Model.  Under the Pioneer ACO Model,
beneficiaries will maintain the full benefits available under
traditional Medicare (fee-for-service), as well as the right to receive
services from any healthcare provider accepting Medicare patients.

To ensure beneficiaries receive high quality care and enjoy a positive
experience, CMS has established robust quality measures that will be
used to monitor the quality of care provided and beneficiary
satisfaction.  These measures mirror those in the Shared Savings
Program.  For more 

information, visit www.cms.gov/sharedsavingsprogram and view the fact
sheet entitled "Improving Quality of Care for Medicare Patients:
Accountable Care Organizations."

More information about beneficiary protections and quality measures is
available in the fact sheet entitled "The Pioneer ACO Model: A Better
Care Experience Through a New Model of Care."

 

Eligibility Criteria/Program Requirements

To be eligible to participate in the Pioneer ACO Model, organizations
are required to be providers or suppliers of services structured as: 

1) ACO professionals in group practice arrangements; 

2) Networks of individual practices of ACO professionals; 

3) Partnerships or joint venture arrangements between hospitals and ACO
professionals; 

4) Hospitals employing ACO professionals; or 

5) Federally Qualified Health Centers (FQHC). 

 

Health Information Technology

By the end of 2012, Pioneer ACOs must attest and CMS will confirm that
at least 50% of the ACO's primary care providers have met requirements
for meaningful use of certified electronic health records (EHR) for
receipt of payments through the Medicare and Medicaid EHR Incentive
Programs. 

 

Minimum Number of Aligned Beneficiaries

Beneficiaries are aligned to ACOs through the healthcare providers that
choose to participate.  

CMS will review where a beneficiary has been receiving the plurality of
his/her primary care services, and use that information to establish
which beneficiaries are aligned to a participating provider.  If a
primary care provider chooses to participate in an ACO, the
beneficiaries aligned to him or her through this process would be
aligned to the ACO.  If a beneficiary receives less than 10 percent of
their care from a primary care provider, CMS will review where a
beneficiary has been receiving the majority of his/her specialty
services to determine alignment.

Participants generally must have a minimum of 15,000 aligned
beneficiaries unless located in a rural area, in which case are to have
a minimum of 5,000 beneficiaries. In order to be aligned, beneficiaries
must be enrolled in original, fee for service Part A and B Medicare.
They cannot be participating in Medicare Advantage plans.  

 

Participation of Other Payers

The Innovation Center believes that Pioneer ACOs will be more effective
in producing improvements in three part aim of better care for
individuals, better health for populations, and slower growth in
expenditures if they fully commit to a business model based on financial
and performance accountability. The Innovation Center therefore requires
Pioneer ACOs to enter similar contracts with other payers (such as
insurers, employer health plans, and Medicaid) such that more than 50
percent of the ACO's revenues will be derived from such arrangements by
the end of the second Performance Period. 

 

Selection Process 

CMS conducted a lengthy, open and competitive application process to
select the final participants in the Pioneer ACO Model.  CMS released a
Request for Applications (RFA) in May 2011 that detailed the selection
criteria.  Applicants were required to submit both a Letter of Intent
and Application.  Applications were reviewed by a panel of experts from
the Department of Health and Human Services as well as from external
organizations, with expertise in the areas of provider payment policy,
care improvement and coordination, primary care, and care of vulnerable
populations.  These panels assessed the applications based on the
criteria detailed in the RFA.  Applicants with the highest scores were
invited to participate in interviews with Innovation Center leadership
at the CMS facility in Baltimore.  Based on these interviews, CMS chose
a pool of finalists.  The Pioneer ACOs announced in December 2011 were
those finalists choosing to sign a final agreement with CMS.

 

Pioneer ACO Model and the  Shared Savings Program 

The Pioneer ACO Model is distinct from the Shared Savings Program. The
Shared Savings Program fulfills a statutory obligation set forth by the
Affordable Care Act to establish a permanent program that develops a
pathway forward for groups of health care providers to become ACO's,
while the Pioneer ACO Model is an initiative designed to test the
effectiveness of a particular model of payment. Final rules for the
Shared Savings Program were published in November 2011.  More
information is available at www.cms.gov/sharedsavingsprogram .

 

The Pioneer ACO Model differs from the Medicare Shared Savings Program
in the following ways, among others: 

The first two years of the Pioneer ACO Model are a shared savings
payment arrangement with higher levels of savings and risk than in the
Shared Savings Program. 

Starting in year three of the initiative, those organizations that have
earned savings over the first two years will be eligible to move to a
population-based payment arrangement and full risk arrangements that can
continue through optional years four and five. 

Pioneer ACOs are required to develop similar outcomes-based payment
arrangements with other payers by the end of the second year, and fully
commit their business and care models to offering seamless, high quality
care. 

 

Additional Information

Additional information about the Pioneer ACO Model is available on the
Pioneer ACO Model 

website - http://www.innovations.cms.gov/initiatives/aco/pioneer

 

Pioneer ACO Model

UPDATED - new deadlines for Letter of Intent and Application
(06/08/2011)
<http://innovations.cms.gov/areas-of-focus/seamless-and-coordinated-care
-models/pioneer-aco-application/> 

Learn more about the Open Door Forum on the Pioneer ACO Model held on
June 7, 2011 by visiting the Events Archive page
<http://innovations.cms.gov/news/events-archive/> .

The Pioneer ACO Model is designed for health care organizations and
providers that are already experienced in coordinating care for patients
across care settings. It will allow these provider groups to move more
rapidly from a shared savings payment model to a population-based
payment model on a track consistent with, but separate from, the
Medicare Shared Savings Program. And it is designed to work in
coordination with private payers by aligning provider incentives, which
will improve quality and health outcomes for patients across the ACO,
and achieve cost savings for Medicare, employers and patients.

The payment models being tested in the first two years of the Pioneer
ACO Model are a shared savings payment policy with generally higher
levels of shared savings and risk for Pioneer ACOs than levels currently
proposed in the Medicare Shared Savings Program. In year three of the
program, participating ACOs that have shown a specified level of savings
over the first two years will be eligible to move a substantial portion
of their payments to a population-based model. These models of payments
will also be flexible to accommodate the specific organizational and
market conditions in which Pioneer ACOs work.

The Pioneer ACO Model includes strong patient protections to ensure that
patients have access to and receive high quality care. To accomplish
this goal, Pioneer ACOs will be expected to improve the health and
experience of care for individuals, improve the health of populations,
and reduce the rate of growth in health care spending. Participating
ACOs will be held financially accountable for the care provided to their
aligned beneficiaries. In addition, CMS will publicly report the
performance of Pioneer ACOs on quality metrics, including patient
experience ratings, on its website.

 

 

-------------- next part --------------
An HTML attachment was scrubbed...
URL: <http://kilakwa.net/pipermail/nyaprs_kilakwa.net/attachments/20111219/6f81c3ea/attachment.html>