Facing mounting criticism about the proposed rule to implement provisions in the Affordable Care Act (ACA) creating Medicare shared savings accountable care organizations (ACOs), on May 17, 2011, the Centers for Medicare and Medicaid Services (CMS) rolled out three new ACO initiatives that address some of the issues stakeholders have raised.

CMS Administrator Don Berwick and senior staff in the Center for Medicare and Medicaid Innovation ("The Innovation Center") announced new initiatives to help healthcare providers become ACOs. The Innovation Center has broad authority to test and evaluate new payment and service delivery models. The ACA included $10 billion in funding for FY 2011-19 for this effort, one of the largest discretionary funding pools included in the law.

The comment period for the proposed rule does not close until June 6, and the agency normally does not respond to public reaction until a final rule is released. The May 17 announcements are indicative of the public interest in the ACO concept and CMS's need to maintain momentum on this fundamental change to the healthcare delivery system.

Pioneer ACO Model

The new Pioneer ACO Model will provide a faster path for health care organizations and providers that are already experienced in coordinating care for patients to become an ACO. This model will allow providers to move rapidly to an advanced shared savings model and population-based payments. The model’s design allows collaboration with state and private payers, prospective beneficiary assignment, potentially extends the contract period, and requires organizations to be eligible for higher levels of shared savings and risk. CMS hopes to have 30 ACOs up and running under this model by fall.

Organizations interested in becoming a Pioneer ACO will need to submit a letter of intent by June 10, 2011. Applications should be submitted by July 18, 2011. More information about applying to the Pioneer ACO Model is available, as is the full Pioneer Model Request for Application.

Advance Payment

The Innovation Center is seeking comment on an Advance Payment Initiative that would give ACOs participating in the Medicare Shared Savings Program access to their shared savings up front. CMS's intent is to help provider groups who lack ready access to capital for the infrastructure and staff investments needed for a successful ACO. The potential high cost of the start-up, as outlined in the proposed rule, was one of the first complaints leveled against it. This initiative is seen as a way to address that concern. In order to participate in the initiative, ACOs would need to provide a plan stating how they will use the funds to build care coordination capabilities. Organizations could receive an advance on the shared savings they are expected to earn as a monthly payment for each assigned Medicare beneficiary. The advanced payments would be recouped through the ACOs' earned shared savings. Comments should be submitted by email to advpayACO@cms.hhs.gov by June 17, 2011.

Accelerated Development Learning Sessions

Recognizing that care coordination is a new concept to many health providers, CMS is offering free ACO Accelerated Development Learning Sessions (ADLS) to provide leaders from healthcare delivery organizations who are interested in becoming ACOs an opportunity to learn what steps they can take to provide better-coordinated care.

Four learning sessions will be offered in 2011, the first of which will be held June 20–22 in Minneapolis. Each session will offer a focused curriculum on core competencies for ACO development. Examples include improving care delivery to increase quality and reduce costs; building capacity to assume and manage financial risk; and effectively using health information technology and data resources. Registration information and the ADLS draft agenda are both available online.

Other CMS ACO Activities

CMS continues to seek stakeholder comment on the Medicare Shared Savings Program proposed rule. On May 24, 2011, CMS held a national provider teleconference to provide an overview, followed by a question-and-answer session. The transcript will be available here by May 31.