TABLE.
Comparison of Payment Arrangements in the Pioneer ACO Modela
| Pioneer Core | Pioneer Option A | Pioneer Option B | Pioneer Alternative 1b | Pioneer Alternative 2c | |
|---|---|---|---|---|---|
| Year 1 | 60% 2-sided10% sharing cap10% loss cap1% MSR | 50% 2-sided5% sharing cap5% loss cap1% MSR | 70% 2-sided15% sharing cap15% loss cap1% MSR | 50% 1-sided5% sharing cap2%-2.7% MSR (depending on number of aligned beneficiaries) | 60% 2-sided10% sharing cap10% loss cap1% MSR |
| Year 2 | 70% 2-sided15% sharing cap10% loss cap1% MSR | 60% 2-sided10% sharing cap10% loss cap1% MSR | 75% 2-sided15% sharing cap15% loss cap1% MSR | 70% 2-sided15% sharing cap15% loss cap1% MSR | 70% 2-sided15% sharing cap15% loss cap1% MSR |
| Year 3 | Payment: Population-based payment of up to 50% of ACO's expected Medicare Part A & B revenue | Payment: Population-based payment of up to 50% of ACO's expected Medicare Part A & B revenue | Payment: Population-based payment of up to 50% of ACO's expected Medicare Part A & B revenue | Payment: Population-based payment of up to 100% of ACO's own expected Medicare Part B revenue, less 3% discount | Payment: Population-based payment of up to 100% of ACO's own expected Medicare Part A & B revenue, less 3% discount |
| Year 3 | Risk: 70% 2-sided 15% sharing cap 15% loss cap 1% MSR | Risk: 70% 2-sided 15% sharing cap 15% loss cap 1% MSR | Risk: 75% 2-sided 15% sharing cap 15% loss cap 1% MSR | Risk: Full risk for all Medicare Part B with a discount of 3% to 6% (depending on quality scores) and shared risk for Medicare Part A (70% sharing rate, 15% sharing and loss cap) | Risk: Full risk for all Medicare Part A & B revenue with a discount of 3% to 6% (depending on quality scores) |
| Year 4 | Same as above | Same as above | Same as above | Same as above | Same as above |
| Rebase using 2011, 2012, 2013 | Rebase using 2011, 2012, 2013 | Rebase using 2011, 2012, 2013 | Rebase using 2011, 2012, 2013 | Rebase using 2011, 2012, 2013 | |
| Year 5 | Same as above | Same as above | Same as above | Same as above | Same as above |
a
ACO = accountable care organization; MSR = minimum savings rate.
b
Seton Health Alliance selected Pioneer Alternative 1.
c
Genesys PHO selected Pioneer Alternative 2.
Adapted from Center for Medicare and Medicaid Innovation.4