But, asks the Disease Management Care Blog, how do we really know that that Hadrosaurus wasn't pretending to be dead when the T rex took its bite? Alternatively, the Hadrosaurus could have been sleeping and only looked dead to a slow-witted and lazy T rex.
Dino doubts, says the DMCB, remain.
Such is the level of skepticism that the DMCB is bringing to its reading of the recent CMS press release describing the initial results of the Pioneer ACO program . CMS says "positive" and "promising." The DMCB says "problematic" wonders if, like the T rex dilemma, there isn't an alternative interpretation.
According to the press release, the health care costs for the 669,000 Medicare beneficiaries cared for by the 32 Pioneer ACO program providers grew only .3% versus .8% for a parallel group of "similar beneficiaries." 13 organizations exceeded the savings threshold, which will lead to Uncle Sam writing checks for $76 million in shared savings.
This front page article in The Wall Street Journal has more detail . It says 18 of the 32 reduced health care costs, which leads the DMCB to conclude that five otherwise "successful" participants did not cross the required savings threshold. Two participants lost money. That, in turn, suggests the remainder, or twelve, broke even.
Details on how each individual institution fared are not readily available. According to WSJ, Boston's Partners Healthcare reduced Medicare claims expense by $14 million. They will be rewarded with a shared savings check of $7 million. Wisconsin's Bellin-ThedaCare will get "several million."
Good "win-win" news for the Pioneer organizations, CMS, Uncle Sam and U.S. taxpayers, right? A critical mass (40%) achieved millions in shared savings, which means proof of concept met and that a key part of Obamacare is successful, right?
That's 19 losers or almost 60% of the participating organizations.
In addition, it's possible that for some of the 13 "winners" that the shared savings awards won't match their up-front multi-million dollar investment either. Assuming that's true, it's possible that as many as two thirds of the Pioneer organizations lost money. No wonder 9 of the participants have signaled a desire to exit the program .
The DMCB's dinosaur analogy may be apt. Given a two out of three likelihood of losing millions in the first year of operations, ACOs may just be too big and complicated to survive in the current health care environment. Nonetheless, the Pioneer program will continue and the DMCB will stay tuned for the Year 2 results.
In the meantime, the DMCB wishes CMS good luck in using these "positive" and "promising" results to expand the program anytime in the near - or distant - future.