More than $80 million paid out to Pioneer ACO beneficiaries, report finds

Nearly $81 million has been made in payments on behalf of beneficiaries in Pioneer accountable care organizations through Sept. 30, a new report finds.

The report from the Centers for Medicare & Medicaid Services, released Dec. 30, also says 24,000 beneficiaries are participating in a CMS Innovation Center initiative to reduce preventable hospitalizations among nursing facility residents.

The project involves seven organizations partnering with 146 nursing facilities in seven states. The goal is “test strategies to reduce unnecessary hospitalizations of Medicare-Medicaid enrollees who are long-stay residents of nursing facilities, while at the same time maintaining or improving quality of care.” 

The report tracks activity from Nov. 1, 2012, to Sept. 30, 2014. It found there was slightly more than $87 million in funding to support development and testing of the Pioneer ACO model, and $40.4 million was allotted towards development of Bundled Payments for Care Improvement.

Pioneer ACOs generated total program savings of $87 million in their first year of operation with savings to the Medicare Trust Funds of nearly $33 million, the report said. It found that, on average, Medicare spending per beneficiary per month was about $20 less than if beneficiaries had not been aligned with an ACO in their market.

CMS was estimated to have paid $70.5 million under state demonstrations to integrate care for Medicare-Medicaid enrollees, also called dual eligibles.

The Pioneer ACO model began in 2012 with 32 ACOs. Nineteen remain and plan to enter their fourth performance year in 2015.

The report can be seen here.