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Podcast: How the Pioneer ACO Fallout Affects the Future of Risk-Based, Population Health

November 25, 2014
by Gabriel Perna
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Krista Bowers

With the viability of the Pioneer ACO program in question, how should healthcare provider organizations looking to take on risk move forward? That question is posed in the latest edition of the Healthcare Informatics podcast, with Krista Bowers, managing director of the Miami-based consulting firm, BDC Advisors.

Bowers and BDC recently wrote a report on the future of accountable care after it was announced that three more organizations dropped out of the Centers for Medicare and Medicaid Services’ (CMS) Pioneer Program. This has left 19 of the original 32 ACOs, with only 13 of them having saved money, according to CMS’ recent release of the financial results from years one and two of the program.

In the podcast, Bowers and HCI Senior Editor, Gabriel Perna speak about where this news leaves the future of the Pioneer program. “Overall, it really shows the challenge of the program and the challenge that coordination of care will face in this program,” she says.

Those still in Pioneer ACOs that are attempting to coordinate care through health IT systems, Bowers says, are finding a negative return on investment (ROI). She says the investments are necessary to move forward healthcare but the ROI for those in government-based ACOs will be a huge challenge. Instead, she suggests those using health IT systems that are looking to take on risk-based contracts and management populations of health should go with Medicare Advantage.

“There are a couple of advantages for Medicare Advantage over the MSSP (Medicare Shared Savings Program) or the Pioneer ACO program. It’s network-based. People are assigned to a network, whereas in an ACO there is not necessarily a network affiliation. These patients can go anywhere at any time,” Bowers says. She also says the incentives are more aligned in Medicare Advantage.

One of the big issues with the ACOs, Bowers says, is the fact that patients don’t know they are even in one. This patient attribution issue is a factor for even the most successful of ACOs, she says.

In the last part of the podcast, Bowers makes predictions on the future of population health and whether Medicare will be a bellwether for the private market.

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