Dartmouth-Hitchcock Shows Savings, Meets Quality Measures in First Year of Pioneer ACO Program

July 17, 2013
Lebanon, NH

by Rick Adams

Photo: Three care coordinators talking

(Photo by Mark Washburn)

Dartmouth-Hitchcock is among the health systems showing "positive and promising results" from the first year of the Pioneer Accountable Care Organization (ACO) model, announced July 16 by the Centers for Medicare and Medicaid Services (CMS).

In its first year - calendar year 2012 - the Dartmouth-Hitchcock project generated savings to the federal Medicare health program under the Pioneer model, in which groups of doctors and other healthcare providers work together to provide high quality care for their patients, making a rapid transition to higher quality care at a lower cost to Medicare. Dartmouth-Hitchcock's share of the savings will come to just over $1 million. Dartmouth-Hitchcock also met all quality benchmarks under the program, including monitoring of patients with chronic conditions who may be at risk for complications, ensuring that Medicare patients' preventive health needs are met, and lower hospital admission and readmission rates.

"Our Pioneer model is showing real gains in providing coordinated, high-quality care for our Medicare patients, while lowering the cost of that care," said Dr. Barbara Walters, Dartmouth-Hitchcock's Senior Medical Director for Regional Practices, who is leading Dartmouth-Hitchcock's Pioneer project. "I'm encouraged that we're on the right track, and that we will continue to move closer to the goal of showing that we can successfully move away from fee-for-service payment models to a value-based model."

Made possible by the Affordable Care Act, the Pioneer ACO Model encourages providers and caregivers to deliver more coordinated care for Medicare beneficiaries. This model, launched by the CMS Innovation Center, is part of the Affordable Care Act's efforts to realign payment incentives, promoting high quality, efficient care for Medicare beneficiaries. ACOs, including the Pioneer ACO Model and the Medicare Shared Savings Program, are one way CMS is providing options to providers looking to better coordinate care for patients and use health care dollars more wisely.

Dartmouth-Hitchcock's Pioneer project covered just over 17,000 patients, with an average annual expenditure of $9,815 per patient, compared to an annual expenditure of $10,501 for CMS's "adjusted reference population," a national comparison group. For the year, under the base shared savings rate of 60 percent, Dartmouth-Hitchcock will receive $1,003,743 with CMS keeping the balance.

"Developing and testing new payment models like the Pioneer ACO is an important step in moving us toward creating a sustainable health system," said Dartmouth-Hitchcock CEO and President Dr. James N. Weinstein. "To create the sustainable health system, we need to move away from the market- and volume-based models to more population health- and value-based models."

Dartmouth-Hitchcock has been a leader in developing value-based models of payment for care, including the Physician Group Practice demonstration project that preceded the Pioneer program and several similar projects with private insurers. Dartmouth-Hitchcock has also partnered with Fletcher Allen Health Care in Vermont to create OneCare Vermont, a similar ACO project under the Medicare Shared Savings Program (MSSP.)

"The question now is: what comes next, after ACO's?" adds Weinstein. "How do we take what we've learned from the Physician Group Practice demonstration and Pioneer models and build it out to improve the health and health care of our population?"

Dartmouth-Hitchcock was also among all 32 Pioneer ACOs that successfully reported quality measures and achieved the maximum reporting rate for the first performance year, with all earning incentive payments for their reporting accomplishments. Overall, Pioneer ACOs performed better than published rates in fee-for-service Medicare for all 15 clinical quality measures for which comparable data are available.

To learn more about the Pioneer ACO Model, visit

About Dartmouth-Hitchcock

Dartmouth-Hitchcock is a national leader in patient-centered health care and building a sustainable health system. Founded in 1893, the system includes New Hampshire's only Level 1 trauma center and its only air ambulance service, as well as the Norris Cotton Cancer Center, one of only 41 National Cancer Institute-designated Comprehensive Cancer Centers in the nation, and the Children's Hospital at Dartmouth-Hitchcock, the state's only Children's Hospital Association-approved, comprehensive, full-service children's hospital. As an academic medical center, Dartmouth-Hitchcock provides access to nearly 1,000 primary care doctors and specialists in almost every area of medicine, as well as world-class research at the Audrey and Theodor Geisel School of Medicine at Dartmouth.

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