The Pioneer program is Medicare's most ambitious test of the ACO model, involving provider systems that have the most experience in managing population health. They receive bonuses if they meet quality and cost benchmarks and losses if they fail to do so. Shared Savings ACOs don't initially face losses for failing to meet targets. The program was established as part of the Patient Protection and Affordable Care Act, under the new Center for Medicare and Medicaid Innovation.
CMS officials say they expect any Pioneers that exit the program to move into another shared savings model. But whether that will happen remains unclear. Blair Childs, senior vice president of public affairs at Premier Healthcare Alliance, said he heard from one Pioneer participant who plans to make a decision Friday. Childs said some of those nine Pioneers might end up staying in the program.
“The initial goal with the Pioneers was that they weren't intending to have as many as they got,” Childs said. “I don't think this is in any way a diminution in the movement that is going on in healthcare, which is a movement toward population health management by healthcare providers.”
Still, Childs said he hopes the CMS will show some flexibility in the program. As he explained, some Pioneers who leave the program might not shift into the Medicare Shared Savings Program because of some of the MSSP's existing rules. For instance, Childs said that in order to join the Medicare Shared Savings Program, participants must use their taxpayer identification number, rather than their Medicare Provider Identification, or MPI, number—which presents a problem if not all doctors want to join the ACO.
“If you're a large physician group and some of the physicians don't want to participate, you can't participate,” he said. “You may have some drop out of Pioneer and then not join MSSP because of this rule.”