Sharp HealthCare Leaves Pioneer ACO Program

John Commins, August 28, 2014

After two and a half years of work to coordinate care for more than 28,000 Medicare beneficiaries, Sharp says it cannot make the financial model work.

Sharp HealthCare ACO is leaving the Pioneer Accountable Care Organization pilot program.

The decision, announced quietly in the company's third-quarter finance report, leaves San Diego with no Pioneer ACOs.

"Because the Pioneer model is based on national financial trend factors that are not adjusted for specific conditions that an ACO is facing in a particular region (e.g., San Diego), the model was financially detrimental to Sharp ACO despite favorable underlying utilization and quality performance," Sharp said its financial report, adding that the Center for Medicare & Medicaid Innovation was notified in June.

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Sharp ACO issued a statement this week explaining that it had worked with the Innovation Center for two and a half years to coordinate care for more than 28,000 Medicare beneficiaries but couldn't make the financial model work.

"Despite meaningful reductions in readmission rates and hospital and skilled nursing utilization, as well as improvements in the required quality indicators in 2012 and 2013 for these beneficiaries, CMMI reported break even financial performance for Sharp ACO in both of these years," Sharp ACO said in a media statement.

John Commins

John Commins is a senior editor at HealthLeaders Media.

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