New Accountable Care Model Could Save $1.1B

32 healthcare organizations chosen to participate in CMS' new Pioneer ACO initiative will begin trial usage of the model in January.

Nicole Lewis, Contributor

December 28, 2011

3 Min Read

12 EHR Vendors That Stand Out

12 EHR Vendors That Stand Out

12 EHR Vendors That Stand Out (click image for larger view and for slideshow)

The new Pioneer Accountable Care Organization initiative set to launch in January in 32 healthcare organizations across the country could save up to $1.1 billion over five years, said the Centers for Medicare & Medicaid Services (CMS).

The initiative, which will be managed by the CMS Innovation Center, marks a significant step in the U.S. Department of Health and Human Services' (HHS) efforts to encourage primary care doctors, specialists, hospitals and other caregivers to offer coordinated care for Medicare beneficiaries.

According to HHS, the Pioneer ACO initiative will test the effectiveness of several innovative payment models as a way to help experienced organizations provide better care for beneficiaries, work in coordination with private payers, and reduce Medicare cost growth. These goals will be achieved as health organizations move away from a payment system based on volume under the fee-for-service model toward a system based on a pay-for-performance model of care.

[ Accountable care requires deeper data analysis. See Accountable Care Lives Or Dies On Performance Data. ]

The Pioneer ACO model requires ACOs to engage other payers in similar efforts to reward healthcare providers that deliver high-quality care. The model is designed for organizations with experience providing integrated care across healthcare settings, and includes strict beneficiary protections, including the ability for patients to seek care from any Medicare provider they wish.

The Pioneer ACO is one of several ACO models, which also include the Medicare Shared Savings Program and the Advance Payment ACO Model, which were announced in October.

"We know that healthcare providers are at different stages in their work to improve care and reduce costs," Marilyn Tavenner, acting administrator of CMS, said in a statement. "That's why we've developed a menu of options for Medicare to meet doctors, hospitals, and other healthcare providers where they are, and begin the conversation of how to enhance the care they are offering to people with Medicare."

Among those participating in the Pioneer ACO program is the San Diego, Calif.-based Sharp HealthCare Accountable Care Organization, which is comprised of an integrated health system that serves nearly 32,000 Medicare beneficiaries in San Diego County.

Officials at Sharp HealthCare see their participation in the Pioneer ACO program as a way to leverage their investments in health information technology to support care coordination and facilitate communication between patients, their physicians and their healthcare team.

"Sharp HealthCare has been investing in electronic medical records and data analytics and we will use point of care tools that enable all members of the healthcare team to see what a patient needs and communicate their findings and actions," Jerry Penso, medical director, Continuum of Care at Sharp Rees-Stealy Medical Group, told InformationWeek Healthcare. "We will continue to expand the functionality of Sharp's patient portal to empower patients to manage their conditions and partner with their care team in improving their health."

When are emerging technologies ready for clinical use? In the new issue of InformationWeek Healthcare, find out how three promising innovations--personalized medicine, clinical analytics, and natural language processing--show the trade-offs. Download the issue now. (Free registration required.)

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