Recently the Boston Globe published the much-anticipated results of the independent actuarial accounting of the results of the first two years of the Pioneer ACOs program of CMMI.(Click here to read the whole article.) I find it impossible to read this without wanting to comment.
Many may not remember that the first accountings of the Pioneer ACO program were somewhat different. In 2013 there was an article in the Globe and in papers across the country that essentially reported the reverse of these results. The initial results were reported on savings against a budget that was a function of previous performance. Those original budgets were highest for those systems that were most expensive and were lowest for those systems that had previously had some success in lowering the cost of care. The “rules” seemed pretty unfair. My thought the time had been, “Once again no good deed goes unpunished” or at other times I regressed to a Southern expression of wisdom, “Oh well, thems that gots, gets” as I pondered the higher budgets of some of the most costly and wealthy medical institutions on the planet.
The release this week is fabulous on several levels. Most importantly it is a verification of the concepts behind the Pioneer ACO. Secondly, the reported successes should encourage other ACOs to examine what was done and try to build on what worked. Finally, the dedicated medical professionals that did the work deserve the recognition. I think it is not a coincidence that Dr. Atul Gawande’s New Yorker article touching on many of these subjects also came out the very same week. We will hear a lot more about this analysis as we all try to extract the lessons and move toward applying what was learned.
Back in 2012 there was controversy, confusion, and uncertainty about how success would really be judged and ambiguity about every aspect of the proposed objectives of the Pioneer ACO project of CMMI. How in the world would we ever lower the cost of care when patients could go to other providers whenever they felt like it? Elliott Fisher encouraged the Pioneers with his bucolic metaphor: “The best fence is a green pasture.” As it turns out, Elliot was right although I would just say that businesses have known for a long time that customers are loyal to organizations which treat them with respect and provide great quality delivered with the highest levels of service. Pioneer has proven that once again.
Pioneer ACOs may not be the perfect answer to all of the dysfunction in healthcare, and the exact structure of Pioneer or even the Medicare Shared Savings ACOs surely can’t be transferred to every patient population and every practice in the country. But Pioneer and MSSP are moves in the right direction, and if nothing else, the report gives credence to what I have believed for a long time:
“The existing deficiencies in health care cannot be corrected simply by supplying more personnel, more facilities and more money. These problems can only be solved by organizing the personnel, facilities and financing into a conceptual framework and operating system that will provide optimally for the health needs of the population.”
The Pioneers demonstrated that more money was not necessary to improve care. Pardon the wordsmithing of Dr. Ebert’s quote: With less money spent the Pioneers did improve care with a new conceptual framework and operating system that did address the health needs of their populations. We should all be encouraged by their success and grateful for their courage and efforts.
