CMS Launches Fast-Track Pioneer ACO Program

The Centers for Medicare and Medicaid Services’ Center for Medicare and Medicaid Innovation has requested applications for a new ACO initiative called the Pioneer Accountable Care Organization Model. The model is designed for healthcare organizations and providers that are already experienced in coordinating care for patients across care settings.

The initiative will test how moving experienced organizations more rapidly to population-based payment arrangements working in coordination with private payers can achieve cost savings across the ACO and improve health outcomes for Medicare beneficiaries.

The Pioneer ACO Model will complement the Medicare Shared Savings Program by testing models that may later be adopted in the Medicare Shared Savings Program. The Pioneer ACO Model differs from the Medicare Shared Savings Program in the following ways:

  • The Pioneer ACO Model requires a longer, five-year agreement.
  • The first two years of the program are a shared savings payment arrangement with higher levels of savings and risk than in the Medicare Shared Savings Program.
  • Starting in year three of the initiative, those organizations that have shown savings over the first two years will be eligible to move to a population-based payment arrangement that can continue through optional years four and five.
  • The Pioneer ACO Model allows for either prospective or retrospective alignment of beneficiaries into ACOs. The procedures for prospective alignment are set forth in the request for applications. Alternatively, retrospective alignment, if desired by the ACO, may require different procedures that can be negotiated with CMS by the applicant during the application process.
  • Pioneer ACOs must be responsible for the care of at least 15,000 aligned beneficiaries (5,000 for rural ACOs).
  • 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.

CMS published a notice requesting applications to participate in the program on May 20. Organizations must submit a letter of intent to CMS’s Innovation Center by June 10. Applications are due by July 19.

“To be eligible to participate in the Pioneer ACO Model, organizations would ideally already be coordinating care for a significant portion of patients under financial risk sharing contracts and be positioned to transform both their care and financial models from fee-for-service to a three part value based model,” according to the notice.

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