A 43-page draft proposal outlining the details of the Pioneer model for accountable care organizations (ACO) was obtained and released Friday by The Hill, a Washington-based political paper.
Remember: CMS delegated its Innovation Center, a health reform creation set to create and experiment with new payment models to reduce program costs, to devise three classes of ACOs: the Pioneer ACO model, Advance Payment ACO Initiative, and Accelerated Development Learning Sessions.
CMS defines the Pioneer ACO is geared towards mature ACOs that have begun coordinating care for patients. The Pioneer ACO model is estimated to save Medicare up to $430 million over three years through more efficient managed care and eliminating redundancy. Pioneer ACOs would also get higher shares of savings, but face higher risk-sharing (PBN 6/27/11).
The draft outlines specifications for the methods that CMS proposes to evaluate and determine the ACO‐aligned population, the reference population, baseline expenditures, the expenditure benchmark, and performance period expenditures.
Here’s a sneak peakof what criteria patients will have to meet in order to be part of the Pioneer ACO:
“To be prospectively aligned to an ACO, a beneficiary must meet each of the following general criteria:
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Must have 12 months of Medicare Part A and B enrollment in the last year of the alignment period;
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Must not have any months of Medicare Advantage (MA) enrollment or Medicare Secondary Payer (MSP) status in the last year of the alignment period;
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Must be a US resident in the last year of the alignment period;
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Must be alive on the last day of the alignment period;
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Must have a plurality of eligible evaluation and management (E&M) services at the ACO during the alignment period…”