The Pioneer ACO Model is designed for health care organizations and providers that are already experienced in coordinating care for patients across care settings. It will allow these provider groups to move more rapidly from a shared savings payment model to a population-based payment model on a track consistent with, but separate from, the Medicare Shared Savings Program. And it is designed to work in coordination with private payers by aligning provider incentives, which will improve quality and health outcomes for patients across the ACO, and achieve cost savings for Medicare, employers and patients.
There are 9 ACOs participating in the Pioneer ACO Model. (List)
To view an interactive map of this Model, visit the Where Innovation is Happening page. expand Read more about interactive map of this Model
Model Details
The payment models being tested in the first two years of the Pioneer ACO Model are a shared savings payment policy with generally higher levels of shared savings and risk for Pioneer ACOs than levels currently proposed in the Medicare Shared Savings Program. In year three of the program, participating ACOs that have shown a specified level of savings over the first two years will be eligible to move a substantial portion of their payments to a population-based model. These models of payments will also be flexible to accommodate the specific organizational and market conditions in which Pioneer ACOs work.
Quality and financial results are provided for Performance Year 1 (2012), Performance Year 2 (2013) and Performance Year 3 (2014) and Performance Year 4 (2015):
- Performance Year 1 (2012) (PDF) | Performance Year 1 (2012) (XPS)
- Performance Year 2 (2013) (PDF) | Performance Year 2 (2013) (XPS)
- Performance Year 3 (2014) (PDF) | Performance Year 3 (2014) (XPS)
- Performance Year 4 (2015) (PDF) | Performance Year 4 (2015) (XPS)
The results provide the total number of beneficiaries aligned to a given Pioneer ACO, benchmark expenditures to which ACO expenditures are compared, actual ACO expenditures and payment from CMS to the ACO as shared savings or paid from the ACO to CMS as shared losses. In order to receive savings or owe losses in a given year, ACO expenditures must be outside a minimum corridor set by the ACO's minimum savings rate (MSR) and minimum loss rate (MLR). If savings/loss is within this corridor, no payment is made to the ACO or owed to CMS. If the Gross Savings/Losses percentage is outside this corridor, then the ACO splits the overall savings/loss with CMS.
Additional Information
General Information
- Frequently Asked Questions
- Fact Sheet (08/25/16)
- Pioneer ACO descriptions document (PDF)
- Pioneer ACO & Next Generation ACO Comparison Table (PDF)
- Open Door Forum - June 7, 2011 Transcript (PDF) | Audio (mp3)
- Request for Information (RFI): Download (PDF) | View submitted RFI comments
Benefit Enhancement Information for Medicare Patients & Caregivers
- I received a Voluntary Alignment form. What is this? (PDF)
- What is the 3-day Skilled Nursing Facility Rule Waiver? (PDF)
Beneficiary Enhancements
Performance Results
- Pioneer ACO Performance Year 1 quality and financial results (PDF) | (XPS)
- Pioneer ACO Performance Year 2 quality and financial results (PDF) | (XPS)
- Pioneer ACO Performance Year 3 quality and financial results (PDF) | (XPS)
- Pioneer ACO Year One Evaluation Report (PDF)
- Pioneer ACO Year One and Two Evaluation Report (PDF)
- Pioneer ACO certification (PDF)
- Pioneer ACO Press Release: Certification
Financial Methodology and Payment Information
- Pioneer ACO Benchmark Methodology for Performance Years 1-3 (PDF)
- Pioneer ACO Benchmark Methodology for Performance Years 4-5 (PDF)
- Pioneer ACO Alternative Payment Arrangements (PDF)
Press Releases
