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Despite Promising Results, Pioneer ACO Program Loses Two More Organizations

Steward Health Care and Mount Auburn plan to join the Next Generation program

Participants in Medicare's Pioneer Accountable Care Organization (ACO) program continue to quit, with two more announcing their departures even as research finds the program improves care quality

According to FierceHealthcare, Massachusetts' Steward Health Care System and Mount Auburn Hospital will both leave the Pioneer program, but both plan to join Medicare's Next Generation ACO program. While Mount Auburn saved some $14 million during its three years in the program, new rules cutting its patient care budget were expected to result in losses. Steward's ACO saved even more, about $30 million, over the same period, and will switch to the Next Generation program because it expects to perform better financially under the model despite steeper financial risk, according to the article.

"In a lot of ways, [the Next Generation program] is Pioneer ACO on steroids," Sanjay Shetty, MD, president of the Steward physicians network, told the Boston Globe.

Both the exits from the Pioneer program and the plans to join the Next Generation program echo a recent decision by Dartmouth-Hitchcock Health System, which was one of the program's top performers on care quality. The organization said it wasn't saving enough to justify its continued participation, FierceHealthcare previously reported.

Meanwhile, data from the Centers for Medicare and Medicaid Services (CMS) on both the Pioneer and Medicare Shared Savings programs show that while many ACOs in both are improving quality and savings, it's difficult to find a strategy that balances the two, according to a Health Affairs blog post. The data also paint a clearer picture of common features of the more successful ACOs, according to the post. ACOs that are physician-based and ACOs with federally qualified health centers or rural health clinics perform particularly well. Smaller ACOs appear to be associated with better outcomes, according to the post: ACOs with fewer than 6,500 attributed patients saved an average of 1.5%, compared to only 0.5% for larger ACOs.

The 20 Pioneer ACOs and 333 Medicare Shared Savings ACOs collectively generated more than $400 million in net savings last year as well as significantly improving quality of care, with a total of 97 keeping spending far below benchmarks, according to CMS. Within the Pioneer program, ACOs improved on 28 of 33 quality measures, doing an average of 3.6% better across quality measures compared with the year before. ACOs made particularly promising strides in medication reconciliation and screening for clinical depression and follow-up planning.

Source: FierceHealthCare, November 9, 2015.

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