Plus ACO, a partnership between Texas Health Resources and North Texas Specialty Physicians, has plans to leave the Pioneer ACO program by mid-August, but the two organizations say they are open to "remaining in the [Pioneer] ACO program if we can find an economically viable way to do so."
Confirmation that some Pioneer ACOs will leave the Center for Medicare & Medicaid Services' pilot program for accountable care organizations came Tuesday morning, ending weeks of speculation.
CMS revealed that seven of the nine participants will attempt to transition to the Medicare Shared Savings Program, while two are exiting the program entirely. It named all nine, but did distinguish between the ones that intend to transition to MSSP and the two that will drop out completely.
See Also: 9 Pioneer ACOs to Leave Program
HealthLeaders Media has learned that while Plus ACO, a partnership between Texas Health Resources and North Texas Specialty Physicians, plans to leave the Pioneer ACO program by mid-August, the two organizations say they are open to "remaining in the [Pioneer] ACO program if we can find an economically viable way to do so," Wendell Watson, the THR director of public relations said in an e-mail exchange.
The health system and the IPA have requested a meeting with the Centers for Medicare & Medicaid Services to discuss options.
Plus ACO began with approximately 19,000 patients in the first year and grew to almost double that in the second year. It is on pace to save $10 million annually in the first two years of the Pioneer program, Watson says, but the ACO anticipated that with down-side risk in the third year it could be liable for a penalty of between $6 million and $9 million.
"Pioneer ACOs have the option to drop out of the program with no penalty at this point in time. We're at a decision point where we must opt-in or opt-out," Watson added.
Although Plus ACO will cease to exist, Texas Health Resources appears committed to ACOs. It has a commercial ACO with Aetna and is in talks with other commercial payers about ACO arrangements. In addition to Plus ACO, Albuquerque-based Presbyterian Healthcare Services has also confirmed its mid-August departure from the Pioneer ACO program.
In a press statement, Presbyterian Healthcare Services officials said that the integrated delivery system will focus its efforts on its accountable care model of managing the risk of its health plan members and in developing partnerships with employer groups. "The Pioneer ACO population of 12,000 was very small compared to our Medicare Advantage population of 36,400 and the nearly 300,000 lives we manage under full risk contracts."
Margaret Dick Tocknell is a reporter/editor with HealthLeaders Media.
