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 CMS To Expand Pioneer ACO Model

​The Obama administration on Monday announced that it will expand its Pioneer accountable care organization (ACO) model nationwide after an independent review found that the approach saved money while not sacrificing quality.
In a conference call with reporters that amounted to a 30-minute victory lap, Centers for Medicare & Medicaid Services (CMS) executive Patrick Conway said that his agency’s independent Innovation Center had audited the Pioneer model and given it a broad thumbs up.
“The Pioneer ACO model is showing that CMS is capable of delivering better care, smarter spending, and healthier people,” Conway said.
His comments came barely an hour after the Journal of the American Medical Association found that providers in the Pioneer system had saved nearly $183 million that would have been spent in more traditional Medicare fee-for-service models. More than that, satisfaction surveys and other quality measures showed that the Pioneer model was scrimping on dollars, not on quality of care, the JAMA team reported.
“Despite decreases in spending growth, results from this study and previously reported data on Pioneer ACOs’ performance on clinical quality measures suggest it is possible to reduce expenditure growth while maintaining or improving quality in a [fee-for-service] environment,” the researchers wrote. “These results are encouraging, given how historically challenging it has been for physicians to achieve spending reductions in Medicare demonstration projects.”
Intriguingly, though, the JAMA study also found that the number of Medicare days spent either in a skilled nursing center or under home health visits showed “larger increases” in year one of the Pioneer study.
This jibes with forecasts from some experts who’ve argued that skilled nursing stands only to benefit as accountable care and other methods of bundled payment take hold and spread through Medicare.
The Obama administration has already approved expanding the Pioneer model beyond its test phase to include other beneficiaries, CMS’ Conway said Monday. As it stands, nearly 7.8 million Americans are already enrolled in Medicare ACOs, “and we think that number will continue to grow,” he said.
“If you follow the trend line, we’ve been adding several million beneficiaries per year into ACO arrangements,” Conway added. “I think we can expect that to continue.”
Bill Myers is Provider’s senior editor. Email him at Follow him on Twitter, @ProviderMyers.
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