ALBUQUERQUE, NM – Presbyterian Healthcare Services today announced it has been selected to participate in the Pioneer Accountable Care Organization (ACO) model, a new initiative sponsored by the Centers for Medicare and Medicaid Services (CMS) Innovation Center. Through the Pioneer ACO model, Presbyterian will work with CMS to provide Medicare beneficiaries with higher quality, higher value care through enhanced care coordination.

Presbyterian is one of 32 organizations selected for the Pioneer ACO Model in the United States and the only Pioneer ACO in New Mexico.

“Presbyterian’s commitment has and always will be to the patients and members we serve, and this new partnership with CMS moves us yet another step forward in our journey to ensure New Mexicans have access to consistently excellent and efficient healthcare. It is another opportunity for Medicare beneficiaries to access our system, along with our Medicare Advantage plan and the traditional Fee-for-Service path,” said Jim Hinton, President and CEO of Presbyterian Healthcare Services. “Our participation in Pioneer is recognition of the progress we have made in providing value to our patients and members and a strong sign of our commitment to collaborating with CMS and other colleagues to improve our nation’s healthcare system.”

The Pioneer ACO Model is designed to encourage the development of ACOs, which are groups of physicians and other healthcare providers who work together to provide high quality care for their patients. As one in a diverse group of leading-edge healthcare organizations from around the country, Presbyterian was chosen specifically by the Innovation Center to test the effectiveness of several models of payment in helping organizations make a rapid transition to higher quality care at a lower cost to Medicare.

“These Pioneer ACOs represent our nation’s leaders in health systems innovation, providing highly coordinated care for patients at lower costs,” said Marilyn Tavenner, Acting Administrator of CMS. “Presbyterian has demonstrated significant experience in providing high quality, coordinated care, and we are excited to partner with them,” Tavenner said.

Under the Pioneer ACO Model, CMS will provide incentives for participating health care providers who form an organization to coordinate care for patients. Providers who band together through this model will be required to meet quality standards based on patient outcomes and care coordination among the provider team, as well as other measures.

CMS will use robust quality measures and other criteria to reward ACOs for providing beneficiaries with a positive patient experience and better health outcomes, while also rewarding Presbyterian for reducing growth in Medicare expenditures for the same patient population. Unlike a managed care plan, Medicare beneficiaries will not be locked into a restricted panel of providers. The Pioneer ACO Model is not a health plan or managed care plan. Under the Pioneer ACO Model, beneficiaries seeing doctors participating in an ACO will maintain the ability to see any doctor or healthcare provider, as well as the full benefits associated with traditional Medicare.

Today’s announcement was the culmination of a competitive selection process that began in May with the national release of a Request for Applications from CMS. Presbyterian was selected based on its demonstrated capabilities to offer high quality, coordinated care.

The Pioneer ACO Model is one of a number of initiatives developed by the new Innovation Center. The Innovation Center was created by the Affordable Care Act to test new models of health care delivery and payment.

About Presbyterian Healthcare Services

Presbyterian Healthcare Services exists to improve the health of patients, members and the communities we serve. Presbyterian was founded in New Mexico in 1908, and is the state’s only private, not-for-profit healthcare system and its largest provider of care. Presbyterian offers eight hospitals, a statewide health plan and a growing multi-specialty medical group. Presbyterian is the second largest private employer in New Mexico with more than 9,000 respected employees and growing. 

Presbyterian’s Pioneer ACO is based in our Central Delivery System (CDS), located in the counties surrounding Albuquerque in central New Mexico. CDS consists of three acute-care hospitals with over 600 licensed beds and the Presbyterian Medical Group. Hospitals within CDS have received the Leapfrog Award for Patient Safety, Beacon Award for Critical Care Excellence from the American Association of Critical Care Nurses, the Energy Star Award from the U.S. Environmental Protection Agency, and the Consumer Choice Award from the National Research Corporation. 

Helpful Links

For more information about the Pioneer ACO Model, visit the Pioneer ACO website. The Pioneer ACO Model is one of several initiatives underway at CMS designed to encourage the formation of ACOs. For more information, visit www.cms.gov/aco. For more information about the Innovation Center, visit innovations.cms.gov.