Skip to content Skip to navigation

BREAKING NEWS: Nine ACOs to Leave the Pioneer Program

July 16, 2013
by Rajiv Leventhal and Mark Hagland
| Reprints
CMS releases first-year data with varied results

Seven Pioneer accountable care organizations (ACOs) that did not produce savings in the first year of the Pioneer program will switch to another ACO model—the Medicare Shared Savings Program (MSSP)—and two others in the Pioneer program will abandon Medicare accountable care models altogether, according to an announcement from the Centers for Medicare & Medicaid Services (CMS).

CMS did not specify which Pioneer ACOs have applied for transition into the Shared Savings program as well as which two would leave Medicare accountable care entirely, but it did announce the nine organizations leaving the Pioneer program: Primecare Medical Network, University of Michigan, Physician Health Partners, Seton Health Alliance, Plus (North Texas Specialty Physicians and Texas Health Resources), HealthCare Partners Nevada ACO, HealthCare Partners California ACO, JSA Care Partners, and Presbyterian Healthcare Services. Since the announcement by CMS, Healthcare Informatics has confirmed with spokespeople for Plus (North Texas Specialty Physicians and Texas Health Resources) and Presbyterian Healthcare Services that those are the two organizations leaving the Medicare umbrella initiative altogether.

This announcement comes at the same time that CMS announced positive and promising results from the first performance year of the Pioneer ACO model, including both higher quality care and lower Medicare expenditures.

All 32 Pioneer ACOs successfully reported quality measures and achieved the maximum reporting rate for the first performance year, with all earning incentive payments for their reporting accomplishments.  Overall, Pioneer ACOs performed better than published rates in fee-for-service Medicare for all 15 clinical quality measures for which comparable data are available. 

Initial indicators from the first-year results show that the Pioneers were able to slow cost increases. On average, costs for the more than 669,000 Medicare beneficiaries in Pioneer ACOs increased by just 0.3 percent in 2012, compared with 0.8 percent growth for Medicare fee-for-service beneficiaries, CMS said.

However, not all Pioneers were able to cut costs for their beneficiaries. Thirteen Pioneer ACOs produced shared savings with CMS, generating a gross savings of $87.6 million in 2012 and saving nearly $33 million to the Medicare Trust Funds. Pioneer ACOs earned over $76 million by providing coordinated, quality care, while two Pioneer ACOs had shared losses, totaling approximately $4 million. Program savings were driven, in part, by reductions that Pioneer ACOs generated in hospital admissions and readmissions, said the federal agency.

The University of Michigan Pioneer ACO, which includes more than 2,000 physicians from the University of Michigan Medical School’s Faculty Group Practice (U-M FGP) and the IHA physician group, is one organization that has decided to leave the program, reporting that it achieved cost savings of 0.3 percent for the Medicare system in calendar 2012. “We remain firmly committed to the concept of improving healthcare and containing cost growth via the population health model that drives all ACOs,” David Spahlinger, M.D., executive director of the U-M FGP, said in a statement. “This intended change from Pioneer to MSSP will allow us to continue that participation while simplifying our administrative structures and enhancing our partnerships with other physician groups,” he added.

Blair Childs, senior vice president for public affairs at the Charlotte-based Premier health alliance delivered a statement in the wake of the news that providers would be leaving the Pioneer program: “Dropping from the Pioneer program does not mean that providers are abandoning their investments or wavering on the concept of ACOs. Instead, many are moving from Pioneer to the less risky options in the Medicare Shared Savings Program. Others are not changing to MSSP, in some cases because of the existence of unnecessary regulatory barriers, and are instead applying their ACO investments to private contracts with insurers.  All organizations that participated in the Pioneer program deserve praise for stepping up to the plate and making investments in care delivery and risk-based payment. As early adopters, they blazed a trail that can be used to help other providers and CMS in making future modifications to the program,” he said.

Despite the news that nine Pioneers won't continue in the program for year two, CMS administrator Marilyn Tavenner emphasized the program’s positive results in its first year. “These results show that successful Pioneer ACOs have reduced costs for Medicare and improved the quality of care for their patients. The Affordable Care Act has given us a wide range of tools to realign payment incentives in Medicare and Medicaid, and these efforts are already paying off,” Tavenner said in a statement released by CMS.

Overall, more than 250 organizations participate in the Pioneer ACO model and the Medicare Shared Savings Program, serving 4 million Medicare beneficiaries, and more ACOs can join the Shared Savings Program each January.



Lahey Hospital and Medical Center Fined $850K for Potential HIPAA Security Violations

November 25, 2015
Burlington, Mass.-based Lahey Hospital and Medical Center this week agreed to pay $850,000 to settle potential violations of the Health Insurance Portability and Accountability Act (HIPAA) Privacy and Security Rules stemming from a 2011 security breach.

Genomic Medicine Clinic in Alabama Opens its Doors

November 25, 2015
Last week, a genomic medicine clinic opened in Huntsville, Ala. with the aim of utilizing the power of the genomic sequence to identify the causes of illness in children and adults with undiagnosed disease.

DoD, VA Say Interoperability Requirements Have Been Met

November 24, 2015
The Department of Defense (DoD) says that it has met the interoperability requirements for electronic health records (EHRs) as called for in the National Defense Authorization Act (NDAA) of 2014.

Senate Committee Advances Rural Health Care Connectivity Act

November 24, 2015
The U.S. Senate Committee on Commerce, Science and Transportation last week passed a bipartisan bill that would enable rural nursing facilities to tap into funding from the government’s Universal Service Fund for telecommunications and broadband services.

Black Book Research: IT Outsourcing Poised for Growth in Healthcare Payer Sector

November 23, 2015
A new Black Book Research report estimates the demands of data security, population health and value-based benefits solutions—and revenue cycle modernization—will drive the payer IT outsourcing market in excess of $60 billion by the end of 2017.

EHRA, HIMSS Comment on CMS Value-Based Payment Models

November 23, 2015
The Electronic Health Record Association (EHRA) and the Health Information and Management Systems Society (HIMSS) last week weighed in on the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) and voiced concerns about new data reporting requirements and new certification criteria for alternative payment models.

CMS Online Drug Mapping Tool Details Opioid Prescribing Patterns

November 20, 2015
The Centers for Medicare & Medicaid Services (CMS) recently unveiled an interactive online mapping tool which shows geographic comparisons at the state, county and ZIP code levels of de-identified Medicare Part D opioid prescription claims data.

Physician Optimization Project Proves Successful at Emory Healthcare

November 20, 2015
Physicians at the Atlanta, Ga.-based Emory Healthcare removed up to one-third of clicks from their ambulatory workflow and, on average, are spending 36 percent less time finishing charts from home as a result of its physician optimization project.

USDA Awards $23.4M in Grants for Rural Telemedicine Projects

November 20, 2015
In conjunction with National Rural Health Day yesterday, Agriculture Secretary Tom Vilsack announced that the United States Department of Agriculture (USDA) is investing $23.4 million in distance learning and telemedicine projects in rural areas.

Geisinger Health System Launches Patient Refund App

November 20, 2015
Geisinger Health System unveiled last week its ProvenExperience pilot program, which will offer refunds to dissatisfied patients.

Health IT Now Coalition Supports Veterans Telemedicine Bill

November 20, 2015
The Health IT Now Coalition, an organization comprised of healthcare providers, payers, patient groups and employers, wrote an endorsement letter of the Veterans E-Health and Telemedicine Support Act to the bill's cosponsors Senators Joni Ernst and Mazie Hirono.

KLAS: Providers Turn to Outside Firms for Value-Based Care Transitions

November 20, 2015
While some providers may have the ability to make the transition to value-based care (VBC) on their own, the vast majority of them are turning to firms who provide VBC consulting services and VBC managed services, according to a new survey from Orem, Utah-based KLAS Research.

Can Digital Health Tools Help People with Mental Illness Manage Chronic Conditions?

November 19, 2015
Dartmouth Centers for Health and Aging has partnered with Boston-based digital health startup Wellframe to examine the use of mobile technology to help older adults with serious mental illness, such as schizophrenia, self-manage chronic medical conditions.

NIH Announces Funding Opportunities for Precision Medicine Initiative

November 19, 2015
This week the National Institutes of Health (NIH) announced the first set of funding opportunities for the precision medicine initiative, a project unveiled by President Obama back in February that will enroll 1 million volunteers in the next three to four years.

Apixio Launches Cognitive Computing Platform That Extracts and Analyzes Patient Data

November 19, 2015
Apixio Inc., a San Mateo, Calif.-based data science company, announced the launch of its Iris cognitive computing platform designed to bring advanced data insights into healthcare by extracting and analyzing patient data from electronic medical records (EMRs).