In addition to more lucrative gainsharing, the AHA and several Pioneer ACO participants are pushing CMS to improve the flow of data necessary to function effectively in the program. "Hospitals are not getting the data in a significant and timely manner," Thompson said.
Stuart Lockman, who serves as president of the Michigan Pioneer ACO, says receiving timely beneficiary data is essential to containing costs. "We would like to see CMS establish a system to better advise ACOs when their aligned beneficiaries visit out-of-network facilities," he says.
The Promised Land
Barbara Walters DO, who is leading the Pioneer ACO program at Dartmouth-Hitchcock Medical Center in New Hampshire, believes the 1800s wagon train analogy works well, to a point. While she agrees Pioneer ACO participants have been blazing a value-based trail, she says their destination remains far in the distance.
"The Promised Land is a little more difficult to see, as we don't have Moses, the angel Moroni or Allah with rules to guide us," Walters said. "But I would say that we would see an engaged patient population participating in a patient-centered model of healthcare, health and wellness, with all relevant data up-to-date and accessible."
The ideal the ACO model would be "supported by an innovative provider community that is fairly reimbursed in a manner that reflects the appropriate cost of care for the illness burden inherent in their population, rewards effective clinical outcomes, and enhances innovative care model designs across the continuum of care," Walters said.