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Pioneer Program ACO Accountable Care Organization CMS Program

32 Health Systems to Participate In Pioneer ACO Program

HHS has announced that thirty-two leading health care organizations have been named as participants in the new Pioneer Accountable Care Organizations (ACOs) initiative under the Affordable Care Act.  The Pioneer ACO initiative will encourage primary care doctors, specialists, hospitals and other caregivers to provide better, more coordinated care for people with Medicare.  HHS claims that this could save up to $1.1 billion over a five year period.

The Pioneer program is operated by the Centers for Medicare & Medicaid Services (CMS) Innovation Center (Innovation Center).  The program aims to reward groups of health care providers that have formed Accountable Care Organizations based on how well they are able to improve the health of their Medicare patients and lower health care costs.  The Pioneer program was announced in October of 2011 after initial Accountable Care Organization Regulations chilled providers who had been contemplating the formation of ACOs.  Various ACO and Pioneer Program options are outlined by CMS as the following link.  ACO Options

The 32 Pioneer ACOs underwent a rigorous competitive selection process by the Innovation Center, including extensive review of applications and in-person interviews.  According to HHS, the initiative will test the effectiveness of several innovative payment models and how they can help experienced organizations to provide better care for beneficiaries, work in coordination with private payers, and reduce Medicare cost growth.  The Pioneer ACO model requires ACOs to engage other payers in similar efforts to reward health care providers that deliver high-quality care. The Pioneer ACO model also includes strict beneficiary protections, including the ability for patients to seek care from any Medicare provider they wish.

The first performance period of the Pioneer ACO Model will begin January, 1st 2012.  The final list of initial participants in the Pioneer Program is contained on the CMS Fact Sheet.

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John H. Fisher

Health Care Counsel
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