• The new, improved ACO rules

    The health law folks at McDermott, Will & Emery (my former firm) have a handy guide to the new Pioneer ACO rules coming soon from a CMS near you. When the country’s most advanced clinical groups threatened to sit out the ACO party, CMS suddenly became more flexible. Two key rules to weed out the newbies:

    • Pioneer ACOs must derive at least 50 percent of total revenue from outcome-based contracts by the end of the second performance period (end of calendar year 2013); and
    • Pioneer ACOs must have at least 15,000 aligned beneficiaries (5,000 for rural Pioneer ACOs).

    If this is going to work, CMS must keep it simple. Perhaps they should study the BCBS-MA alternative quality contract?

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