Being a Pioneer on the ACO Trail is Not Easy

Now it is official that, after only one year, nine Medicare Pioneer accountable care organizations — among those who did not produce savings in their first year in the program — will leave the Pioneer ACO program for the Medicare Shared Savings Progam ACO model. Modern Healthcare reported it, CMS put its own spin on it, and the blogosphere has lit up with speculation.

What can we conclude after one year? 

Very very little about health care finance that we did not already know — health care provider compensation in the United States is premised  on some very entrenched principles, not the least provider insulation from cost and price among them.  Turns out, these entrenched principles are difficult to change. But even some of the departing Pioneer ACOs slowed health care cost growth somewhat. Slowing it enough to generate savings and enough savings to incite provider appetite for assuming both upside and down-side risk is another, longer term, project.

We might also tentatively conclude that it is easier to change provider behavior on quality than it is on cost.  A number of the departing Pioneer ACOs had significant — albeit short term– success in meeting quality benchmarks such as lowering risk-adjusted hospital readmission rates and improving  diabetes care. This is also not unexpected. Health care is likely to grow more expensive before it gets cheaper under the ACA.

Why the rush to try and draw conclusions after one year of Pioneer ACO experience?

We are an impatient people.  This is our virture and our vice. Whitman was correct. We are a resistless restless people.

Let's try not to draw too many firm conclusions too soon from a program just born.

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