Pioneer ACOs Seen Defecting to MSSP Program

Margaret Dick Tocknell, July 8, 2013

At least four of the 32 Pioneer ACOs are in the process of notifying their providers that they intend to shift to the Medicare Shared Savings Program, and up to five more could follow. "They've learned that they probably won't be successful, so they want to move into a no-risk environment," says one observer.

Pioneer ACO models

Map of Pioneer ACO models

At least four accountable care organizations are in the process of notifying their providers that they intend to move out of the Center for Medicare & Medicaid Services' Pioneer ACO program and into the Medicare Shared Savings Program.

As many as nine of the 32 Pioneer ACOs may eventually shift, but only four are known to be actively pursuing a change now. They have until July 15 to notify CMS of their intentions.

CMS declined to identify the departing Pioneer ACOs, but released this statement: "Each of these organizations made its decision based on its particular business priorities and concerns. We're encouraged that these systems want to continue in these programs that promote better care at lower costs. We fully anticipated that as these programs get up and running, some systems would shift between models."

The Pioneer program was developed as an alternative to the MSSP after organizations experienced with coordinating patient care and managing risk complained that the MSSP program was too stringent in its design.

The initial commitment to the Pioneer program is three years. The program is in its second year. By design, the first two years of the Pioneer model are a shared savings payment arrangement. In the third year, according to the CMS program description, "those organizations that have shown a certain minimum amount of savings over the first two years will be eligible to make a transition away from fee-for-service payment to population-based payment and full risk arrangements."

Margaret Dick Tocknell Margaret Dick Tocknell is a reporter/editor with HealthLeaders Media.
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