It’s often said that our society is one steeped waist-deep in impatience. We want fast Internet, fast food, quick news, overnight deliveries. And this culture of immediate gratification pervades virtually every realm of society, even healthcare. 

 

This form of impatience – many say warranted – can be observed in the outcomes of the Pioneer Accountable Care Organization Model, established by CMS, which initially boasted 32 member organizations, but recently the agency announced that nine have jumped ship from the program, with two groups washing their hands of CMS ACOs altogether. 

 

Ken Perez, director of healthcare policy at MedeAnalytics, wasn’t too surprised.

 

"It’s a challenging program," he told Healthcare IT News. The Pioneer model, he said, "just doesn’t generate the quick hits, the quick returns that folks would really like to have."

 

And when you’re financially strapped and mentally discouraged from not seeing big changes, patience is a virtue that’s very difficult to attain. 

 

[See also: Some Pioneer ACOs proving their prowess.]

 

Plus ACO, which includes Texas Health Resources and North Texas Specialty Physician, is one group leaving the Pioneer model and will not be participating in a shared savings ACO either. Texas Health spokesperson Wendell Watson told Healthcare IT News one of the biggest challenges they experienced was that targets were not set at the beginning of the year.

 

"Pioneer model’s benchmarks can move throughout the plan year," he wrote in an emailed statement. And that's like trying to get a bull's eye on a moving target. Because of how the benchmarks were set, Plus ACO is at risk of paying $6 million to $9 million in annual penalties. 

 

The other eight saying sayonara to the Pioneer program include: Prime Care Medical Network; University of Michigan; Physician Health Partners; Healthcare Partners Nevada ACO; Healthcare Partners; California ACO; JSA Care Partners; and Presbyterian Healthcare Services. 

 

For Denver-based Physician Health Partners – one of the nine groups dropping out of the Pioneer model but vowing to continue with a shared savings plan – the benchmark setting process within the Pioneer needed some serious re-working.

 

Considering there’s still significant tweaking going on with benchmarks, "We can’t take that much risk when the game keeps changing a little bit," Kenneth Nielsen, president and CEO of Physician Health Partners, told Healthcare IT News, especially when these adjustments aren’t geographically based. "The Denver market, where our benchmark was $8,000 per beneficiary, per year is a lot different than an East Coast market where their benchmark was twice that."

 

For PHP, it wasn’t all bad news, however. They were able to decrease their readmissions and hospitalizations rates and met all the quality metrics. But, financially, it wasn’t viable. They reported shared losses for fiscal year one, which was anticipated, Nielsen says, but another two years before reaping the supposed financial benefits? It proved just too risky. "We just weren’t able to take enough time to take the risk over three years at this point," Nielsen added. Right now, he said, "We’re between bleeding edge and cutting edge."

 

MedeAnalytics’ Perez says this is all too common. Stepping down to a shared-savings ACO, he opines, is better than ditching the models altogether, but don’t expect the big paybacks years down the road. "It’s kind of like saying, 'We were in the English Premier League in soccer, and we didn’t do very well, so now we’re going to play in the United States, or play basketball in Australia versus the NBA,'" said Perez. "So you’re still in the game, except Kobe Bryant’s not going to shoot over you."

 

[See also: ACOs using remote monitoring.]

 

The good news, he points out, is that all of the ACOs did well from a reporting standpoint in terms of quality. Ten of the 32 also produced collective shared savings of $87.6 million last year. 

 

One problem, however, is that a handful of the 33 quality measures pertain to preventive screenings.

 

"The problem with it, of course, is that preventative care screenings don’t give you a short term financial benefit," Perez explained. "They’re good solid pillars of population health management, but they show the benefits three, four, five years down the road." 

 

Thus, at the end of the day for the Pioneer model, patience does indeed prove itself a virtue, but also a luxury that many cannot afford, as many providers simply don't have the financial or psychological stamina to stick with it and reap the long-term rewards. 

 

Regatta photo from Shutterstock.com.