MSHA Submits Pioneer ACO Application

Accountable care organizations have been a tough sell in the hospital community. Faced with a myriad of complaints about the complexities of the original program, officials at the Centers for Medicare & Medicaid Services introduced the Pioneer ACO. Touted as a way for organizations experienced in care coordination and risk management to more quickly cash in on shared savings, CMS has aggressively promoted the program to potential participants.

The agency has remained remarkably silent regarding interest in the Pioneer ACO program. But now that the deadline for Pioneer applications has passed, a picture is beginning to emerge.

Mountain States Health Alliance, a 13-hospital system based in Johnson City, Tenn., has submitted an application to the CMS to participate in the Pioneer accountable care organization program. MSHA is one of the first participants to publically acknowledge interest in the program.

If the application is approved, MSHA plans to team with Integrated Solutions Health Network  and CrestPoint Health, a third party administrator, to form AnewCareCollaborative. The regional ACO will provide services in the Johnson City and Kingsport areas of northeast Tennessee as well as the Abington area of southwest Virginia.

MSHA is a majority owner in ISHN, which in turn owns CrestPoint Health.

Rob Slattery, president and CEO of ISHN, said the group began to look at the ACO opportunity about a year ago when MSHA was working on its 10-year strategic plan.

“We knew that what got us here wasn’t going to carry us forward.” Slattery said they began to see the ACO, with its triple aim focus - better health, better care and lower costs - as a sustainable model for the group.

With its 13 hospitals and 2,000 physicians, the Mountain States-Integrated Solutions team seems like a natural fit for the ACO healthcare delivery system, which emphasizes care coordination. MSHA already has in place the IT systems that will allow it to capture data on individual patients and follow them through their hospital treatments and physician office visits. Earlier this year it transitioned its 15,000 employees into CrestPoint Health to manage employee health and wellness in a more coordinated manner.

Slattery said Mountain States expects to invest $4 million to $11 million into AnewCareCollaborative, which will manage the healthcare of an estimated 15,000 Medicare beneficiaries. About half of that money will go toward meeting licensure requirements for taking risk in Tennessee and Virginia. He explained that in aligning physicians and hospitals there “may be some capitation arrangements that will require us to become a payer.”

The deadline to apply to participate in the Pioneer ACO program was August 19^th. Slattery said he does not know who else may have applied for the program. He hopes to receive the necessary CMS approvals by the end of 2011 and begin implementing AnewCareCollaborative sometime in 2012.

CMS remains tight-lipped about industry interest in the Pioneer ACO program. In an e-mail exchange, spokesperson, Ellen B. Griffith, would say only that CMS is "not announcing names or numbers of applicants.” CMS has targeted November for announcing the selections. It hopes to select 30 participants for the program.

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