16 Key Provisions of the CMS Pioneer ACO Model

1. Applicants are expected to have extensive experience with systematic care improvement efforts
2. Applicants must have either entered or will enter payment arrangements with other payers that include financial accountability and performance incentives
3. By the end of 2012 at least 50% of the ACO’s primary care providers have met requirements for meaningful use
4. The payment model in the first two years is a shared savings and shared losses payment arrangement with higher levels of savings and risk than in the Medicare Shared Savings Program
5. In year three Pioneer ACOs that have shown savings over the first two years will be eligible to move to a population-based model
6. Payment arrangements will also be flexible to accommodate the specific organizational and market contexts in which ACOs work
7. Pioneer ACOs will also have the option of pursuing a retrospective assignment of beneficiaries in lieu of a prospective assignment
8. Applicant ACOs must also serve at least 15,000 beneficiaries (5,000 in rural areas)
9. Beneficiary Protection and Quality Measure information is available at http://www.cms.gov/apps/media/fact_sheets.asp
10. A target per capita expenditure level (benchmark) based on previous CMS expenditures will be developed for the group of patients aligned to the Pioneer ACO
11. This benchmark will be adjusted based on a combination of the average growth percentage for a reference population, and absolute dollar growth for that reference population
12. Participating ACOs would be judged against this benchmark, and rewarded with a portion of the savings or held accountable for increased expenditures
13. Actual expenditures would have to be outside of a threshold of at least 1 percent to trigger payments or obligations
14. Applicants are encouraged to propose alternative arrangements that include increasing levels of financial accountability, that transition to population-based payment
15. CMS will consider applicant alternative proposals and will synthesize them to offer a second, alternative payment arrangements from which all Pioneer ACOs may choose
16. The Pioneer ACO Model is available for up to 30 qualified organizations. Applicant letters of intent are due June 10, 2011

Source: CMS Fact Sheet: Pioneer Accountable Care Organization Model - May 23, 2011
Source URL: http://innovations.cms.gov/wp-content/uploads/2011/05/Pionee...

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