The Medicare Pioneer ACO Program: What’s Next?
For those of us even vaguely involved in Medicare, the reference to the Pioneer ACO Demonstration program elicits feelings of optimism and relief—optimism because it is an approach to reengineering healthcare and relief because the application submission deadline has come and passed.
Most of you will recall that the Pioneer ACO Demonstration program is a CMS/CMMI initiative to partner with sophisticated integrated provider organizations in an effort to improve the provision of healthcare services to Medicare eligible beneficiaries. The program is one of several initiatives first telegraphed by CMS Administrator Berwick in a November 16th 2010 press release announcing the formation and mission of the Center for Medicaid and Medicare Innovation. In part the mission of the center is to “rigorously and rapidly assess the progress of its programs and work with providers and other payers to replicate successful innovations in communities across the country. It will test models that include establishing “open innovation communities” that will serve as information clearinghouses for best practices of health care delivery reform.
By all indications, the Pioneer demonstration program is envisioned to achieve results which will hopefully become part of the CMS/CMMI toolbox for innovation and best practices. Consequently, those organizations that applied and will be selected are those who can demonstrate a history of patient/provider/payer collaboration; the existence of performance based approaches to delivering superior diagnosis and treatment of patient health issues; the presence of prerequisite governance; infrastructure and technology capabilities to integrate the clinical and financial requirements; and the financial strategies for implementation, operations and income distribution.
The good news is that the application development period is behind us and that those integrated provider systems that were assisted by GHG in their application development and submission process will have an excellent chance of moving to the next phase of the CMMI application evaluation process.
We believe the process will unfold as follows, (however we reserve the right to change our predictions once CMS/CMMI publishes its next update).
First, CMMI will review each application filed for completeness and timely submission. Some of the applications may be rejected outright. Others may be asked to submit additional information, clarify certain supporting documentation or correct omissions. It is highly likely that this initial review process will be quick and applicants will have a short window of opportunity to correct any deficiencies.
Second, those that pass the initial screen for completeness will be contacted by CMMI to schedule a face to face interview. It will focus on the content/detail of the application responses and a thorough Q & A is intended to demonstrate to CMMI the applicant’s familiarity with operating a coordinated clinically and financially integrated delivery system in line with CMMI’s triple —aim vision for Medicare healthcare.
Third, if the applicant interview is successful, CMMI will offer the applicant a contract to operate a Pioneer ACO for a minimum of three years and possibly for at least five years. Fortunately the applicant is not alone in navigating the post Pioneer ACO application development waters—GHG stands ready to provide assistance along every step of the way calling on our senior executives’ long standing experience with the inner workings of CMS.
Those who decided not to apply for the Pioneer ACO demonstration program have not been eliminated from participating in CMMI innovation programs/initiatives, the most recent of which is the recently announced Bundled Payments for Care Improvement Initiatives.
I will be reviewing this new innovations program during my next blog and comment on GHG’s perspective. Until then stay healthy.