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Pioneer ACOs: Lessons Learned from Participants and Dropouts

Monday, September 23, 2013

More than a third of Pioneer ACOs succeeded in reducing costs in Medicare in their first year, according to a recent Centers for Medicare and Medicaid Services (CMS) report. The program initially saved Medicare about $87 million and cut Medicare spending by 0.5 percent.

The Pioneer ACO model is a CMS Innovation Center initiative that was authorized under the Patient Protection and Affordable Care Act. Thirty-two organizations across the nation, which were already experienced in coordinating care for patients throughout care settings, were selected to serve as Pioneer ACOs beginning January 1, 2012. While the majority of Pioneers will continue participation, nine of the thirty-two Pioneer ACOs announced that they would drop out of the program or transition into the traditional Medicare shared-savings program.

What are some of the lessons learned from Pioneer participants? Why are some organizations ending their participation? Are ACOs the right fit for every health care system? How was success measured under this model? Is one year enough time to draw firm conclusions about the program? What kind of progress has been observed in ACOs across the nation?

A distinguished panel of experts will addressed these and related questions.

Elliott Fisher, director of the Dartmouth Institute for Health Policy & Clinical Practice and professor of medicine at Dartmouth, provided an overview of the progress and impact of ACOs nationwide.

Greg Sheff, executive vice president of clinical services at Seton Healthcare Family in Austin, spoke about some of the challenges Seton faced as a Pioneer ACO and why it decided to move into the Medicare Shared Savings Program.

Steve Safyer, president and chief executive officer of Montefiore Medical Center in New York City, discussed some of the successes in quality, outcomes, and costs of care that Montefiore encountered in its first year as a Pioneer ACO.

Ed Howard of the Alliance and Anne-Marie Audet of Commonwealth co-moderated the discussion.

Contact: Marilyn Serafini 202/789-2300

Follow the briefing on Twitter: #ACOs 

The event was sponsored by the nonpartisan Alliance for Health Reform and The Commonwealth Fund.

Transcript, Event Summary and/or Webcast and Podcast

Transcript: Full Transcript (Adobe Acrobat PDF), 9/23/2013
Full Webcast/Podcast: Video: Speaker Presentations

Speaker Presentations

Audet Presentation (Adobe Acrobat PDF), 9/23/2013
Fisher Presentation (Adobe Acrobat PDF), 9/23/2013
Safyer Presentation (Adobe Acrobat PDF), 9/23/2013
Sheff Presentation (Adobe Acrobat PDF), 9/23/2013

(If you want to download one or more slides from these presentations, contact us at info@allhealth or click here for instructions.)

Source Materials

Agenda (Adobe Acrobat PDF), , 9/23/2013
Materials List (Adobe Acrobat PDF), , 9/23/2013
Source List (Adobe Acrobat PDF), , 9/23/2013
Speaker Biographies (Adobe Acrobat PDF), , 9/23/2013

Offsite Materials (briefing documents saved on other websites)

Reforming Medicare integrated care: An alternative to the Obama administration's accountable care organizations, American Enterprise Institute, 8/21/2013
The Many Journeys to Accountable Care, The Commonwealth Fund, 8/6/2013
The Real Promise of 'Accountable Care', The Wall Street Journal, 3/4/2013
ACOs: Making Sure We Learn from Experience, The Commonwealth Fund, 4/12/2012
Accountable Care Strategies: Lessons from the Premier Health Care Alliance's Accountable Care Collaborative, The Commonwealth Fund, 8/9/2012
How one Pioneer ACO save money - and why another one didn't, The Advisory Board, 7/19/2013
JAMA: ACO savings may be 'contagious', The Advisory Board, 8/29/2013
Measuring Progress Toward Accountable Care, The Commonwealth Fund, 12/14/2012
The Promise and Peril of Accountable Care for Vulnerable Populations: A Framework for Overcoming Obstacles, Health Affairs, 8/1/2013
Medicare ACOs growing faster than non-Medicare ACOs, Fierce Healthcare, 8/21/2013
Accountable Care Organizations in Rural America (Adobe Acrobat PDF),Rural Center for Rural Health Policy Analysis, 7/1/2013
Montefiore Pioneer ACO Model Achieves Success in First Year, Montefiore Inspired Medicine, 7/17/2013
Continued Growth of Public and Private Accountable Care Organizations, Health Affairs Blog, 2/19/2013
Taking Stock of Initial Year One Results For Pioneer ACOs, Health Affairs Blog, 7/25/2013
Pioneer Accountable Care Organization Model: General Fact Sheet (Adobe Acrobat PDF),The Centers for Medicare & Medicaid Services, 9/12/2012
Regulatory Neutrality is Essential to Establishing A Level Playing Field for Accountable Care Organizations, Health Affairs, 8/1/2012
The Pioneer ACO First Year Results: A Fuller Picture, Health Affairs Blog, 7/17/2013
A Framework for Evaluating the Formation, Implementation, and Performance of Accountable Care Organizations, Health Affairs, 11/1/2012
Pioneer ACO's Disappointing First Year, Health Affairs Blog, 8/15/2013
The Pioneer ACO Program: A Closer Look at the Numbers, Triple Tree, 9/6/2013
Accountable Care Organizations in Medicaid: Emerging Practices to Guide Program Design, Center for Health Care Strategies, 2/1/2012
Growth and Dispersion of Accountable Care Organizations: August 2013 Update (Adobe Acrobat PDF),Leavitt Partners, 8/1/2013


The bottom line is that there were about 670,000 patients in the 32 Pioneers nationwide and Montefiore had 3% of the patients and earned 17% of the savings for the entire country, Steve Safyer stated at a September 23 Alliance for Health Reform briefing, Pioneer ACOs: Lessons Learned from Participants and Dropouts.


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