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CMS puts positive spin on first-year results for Pioneer ACOs

CMS puts positive spin on first-year results for Pioneer ACOs

Peter Wehrwein

So last week it was all doom and gloom about Pioneer ACOs.

The buzz in health care wonkdom was all about 9 of the 32 organizations defecting from a program supposedly designed for the best and brightest of American health care organizations — with maybe more to follow. Accepting downside risk was just too perilous. Lags in getting data from Centers for Medicare & Medicaid Services (CMS) were undermining cost and quality control efforts. And the contradiction of being responsible (aka accountable) for the costs of Medicare enrollees but having no direct control over where they receive care — a central feature of the ACO model — was simply untenable.

But this morning CMS attempted to change the doleful Pioneer ACO tune with a long-awaited announcement of cost and quality results from 2012, the first year the Pioneer ACOs were in operation.

The government agency spin was unabashedly upbeat: The announcement characterized the results as “positive and promising”

The Wall Street Journal, which got the scoop on the results, was more measured (no surprise there). The headline on this morning’s front-pager is “Mixed Results in Health Pilot Plans.” But story creates a favorable impression with sunny quotes from executives whose Pioneer ACOs had good rookie years and will get back shared savings.

“We did great,” the Journal quotes Gary Gottlieb, president and chief executive of Partners Healthcare in Boston, as saying. “We saved about $14.4 million for Medicare and will get back a little over $7 million.”

Here are a few highlights from today’s CMS announcement:

  • Thirteen of the 32 Pioneer ACOs reduced costs enough to generate savings large enough to split with CMS. The total savings tallied up to $87.6 million. The Journal reported that an additional five Pioneer ACO generated savings but apparently not enough to meet the threshold required for a split with CMS.
  • Two of the 32 had shared losses, totaling $4 million. The Journal identified Atrius Health, a not-for-profit group in Massachusetts, as one of them.
  • All 32 Pioneer ACOs earned the incentive payments available for reporting quality measures.
  • Beneficiaries in 25 of the 32 Pioneer ACOs had lower risk-adjusted hospital readmission rates than regular Medicare fee-for-service beneficiaries.
  • Rates for blood pressure and LDL cholesterol checks of adults with diabetes were higher among the Pioneer ACO beneficiaries than they were for a comparison group of adult diabetics in managed care plans.
  • Seven of the 32 Pioneer ACOs that didn’t generate savings have told CMS they want to leave the Pioneer program for the less-demanding Medicare Shared Savings Program. Two want out of the ACO program altogether, although CMS is not saying which two. Here is a list of the nine ACOs leaving the Pioneer program:
    • Healthcare Partners of California ACO LLC; Los Angeles and Orange Counties, CA
    • Healthcare Partners of Nevada ACO LLC; Clark and Nye Counties, NV
    • JSA Care Partners LLC; Orlando, Tampa Bay, and surrounding areas in South Florida
    • Physician Health Partners LLC; Denver, CO
    • Plus (North Texas Specialty Physicians and Texas Health Resources; Tarrant, Johnson, and Park Counties, North Texas
    • Presbyterian Healthcare Services; Central New Mexico
    • Primecare Medical Network; Riverside and San Bernardino Counties, Southern California
    • Seton Health Alliance; Central Texas
    • University of Michigan; Southeastern Michigan