Pioneer ACO Program Awaits New Rules

Christopher Cheney, for HealthLeaders Media , June 3, 2014

CMS may release as soon as this summer new rules for Medicare's gainsharing programs and a decision on whether to launch a second round of Pioneer ACO participant recruitment.

The Pioneer Accountable Care Organization Model program, one of the most ambitious federal value-based healthcare delivery initiatives, is at a crossroads.

Since launching in 2012 with 32 inaugural participants, the program has dwindled to 23 pioneers. The first year of gainsharing data shows more pain than gain for early Pioneer ACO participants.

Now federal officials appear poised to inject some energy into the initiative, with new rules in the works designed to optimize the program and a second round of participant recruitment on the horizon.

The Pioneer ACO program is one of two gainsharing Medicare payment models; the other is the Medicare Shared Savings Program. From the healthcare provider perspective, the former is a higher risk proposition than the latter.

In the Pioneer ACO program, providers can gain revenue for delivering value, but they lose revenue if they fall short of the program's accountable care standards. The level of gainsharing for MSSP participants is relatively low, but there is no risk of losing revenue through the program.

"Pioneer doesn't have a one-sided gainshare approach. You have up and downside risk," says Nyum Gandhi, a partner at Oliver Wyman Group based in Chicago. "Most of the commercial models and even MSSP are upside only. That's why people view MSSP as a learning opportunity. There's low risk."

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