Providers speculate on the promise and peril of Pioneer ACOs

Providers are telling Modern Healthcare this week about the biggest potential upsides and downsides stemming from their organizations' participation in the Pioneer ACO program. Here are some highlights:

Dr. Mark Girard, president of Steward Health Care Network, says his organization is betting that the changes it has undertaken since its home state of Massachusetts enacted healthcare reforms in 2006 will help it perform well as a Pioneer program.

Potential upsides include less “schizophrenic” payments structures.

“A lot of people exist in a mixed mode where the federal government was paying fee for service and they might have risk contracts on commercial side,” he says. “So by doing this we're less into this mixed mode and more into similar modes so the messaging with our providers, our communities and our patients is the same. It's a little less confusing.”

Todd Sandman, vice president of strategy and customer engagement at Presbyterian Healthcare Services, says his organization expects to spend “a few hundred thousand dollars” as part of their Pioneer participation.

“Because we're a large integrated system already, we have a lot of the infrastructure we need,” he says. “Of course, any time you take what is going to be for us 16,000 patients and make sure we're giving them that approach to care management, we'll spend a little bit more to do that.”

The potential upside his system expects from its participation is not more money but a lower likelihood that it will face the same cuts other providers endure when policymakers begin to ameliorate long-term federal deficits.

Short-term challenges include persuading Medicare beneficiaries in the fee for service program to participate in the intensive care management not traditionally associated with the program, he says.

Similarly, Dr. Barbara Spivak, president of the Mount Auburn Cambridge Independent Practice Association, tells Modern Healthcare that her group's managed-care experience will give it a leg up in providing the types of improved care that the Pioneer program calls for.

The biggest potential obstacles include working with patients who may not be cared for at their own institution. Possible approaches include educating patients and their families to let her group know when they are seeking such care, so that they still receive the post-discharge care needed to avoid complications and re-hospitalizations.

Another potential problem is that patients may opt out of the electronic health record used to coordinate care among their Pioneer providers. In Mount Auburn's experience, most patients agree to put their information in EHRs, but the program can work regardless.

“It's just a lot more complicated,” she says. “And it's harder for the patients.”

Follow Rich Daly on Twitter @MHRDaly.