New “Pioneer ACO” Program to offer fast track toward capitation (but they don’t use the “C” word)

The Center for Medicare and Medicaid Innovation has announced a new “Pioneer ACO” program, available to provider organizations that are already experienced in population management and bearing risk for performance and cost.  The new program has a three year term, with the first 2 years offering a higher level of risk/gain-sharing than is permitted under the draft rules for the regular Medicare Shared Savings Program.  During year 3, if the ACO has exceeded a savings threshold during the prior years, the ACO will be able to opt for a percentage of Medicare reimbursement to be a “population-based model,” which seems to be CMS’s new word for “capitation.”

The program will be designed with some flexibility to facilitate coordination with private payer value-based reimbursement initiatives, seemingly acknowledging that  providers may transition more rapidly if they face consistent reward criteria and metrics across payers.

This Pioneer ACO program will include both quality and patient experience ratings, both of which will be publicly released.  CMS expects about 30 ACOs to participate in this program, each of which will be required to have at least 15K Medicare beneficiaries (or 5K for rural areas).

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