Our experience and strategic excellence in the rural industry

Exploring uncharted territory is familiar terrain for our leadership.

Rural Healthcare is under threat. Long standing designations and rural payment programs for Medicare- and Medicaid-reliant communities are regularly threatened with cuts or elimination.

It’s time to lead through innovation. After considerable research and careful planning, we believe the future of healthcare is moving towards community-based care. Involving not only hospitals and physicians, but also patients, families, businesses, and the community. The first step in our new vision for healthcare is establishing an Accountable Care Organization (ACO). This is the best way to secure a stable future for our hospitals and the communities we serve. There will be winners and losers in this changing healthcare industry. Forming an alliance will equip our rural communities to maintain healthcare services in an evolving and competitive marketplace. So what exactly is an ACO and how will it affect your practice and your patient’s care?

An Accountable Care Organization (ACO) is a network of doctors and hospitals that shares responsibility for the entire cost and experience of care for a group of patients with the goal of limiting unnecessary spending. Effective care begins and ends with the primary care physician. Coordinated care ensures that patients, especially the chronically ill, get the right care at the right time, while avoiding unnecessary duplication of services and preventing medical errors. When an ACO succeeds in both delivering high-quality care and spending health care dollars more wisely, it will share in the savings it achieves for the Medicare program.

As a participant in our ACO, you’ll be accountable for the entire experience of care for Medicare beneficiaries who receive most of their primary care services from you. The Pioneer Health Alliance quality program and our care coordination provide support for improved performance in cost and quality.

As a Pioneer Health Alliance Participant, your patients will receive high quality care, delivered more efficiently, and accessed more conveniently than ever. As a Primary Care Provider, you play a vital role in the Alliance. In addition to your direct personal care, patients will have a Care Coordinator, who, with your guidance, will help them access the continuum of care more easily. Care Coordinators will guide your patients through the system, scheduling appointments, reducing paperwork, tracking the quality of care provided, and supporting patients manage their health at home.

The Centers for Medicare & Medicaid Services (CMS) has established a Medicare Shared Savings Program (Shared Savings Program) to facilitate coordination and cooperation among providers to improve the quality of care for Medicare Fee-For-Service (FFS) beneficiaries and reduce unnecessary costs. Eligible providers, hospitals, and suppliers may participate in the Shared Savings Program by creating or participating in an Accountable Care Organization (ACO).

The Shared Savings Program is designed to improve beneficiary outcomes and increase value of care by:

  • Promoting accountability for the care of Medicare FFS beneficiaries
  • Requiring coordinated care for all services provided under Medicare FFS
  • Encouraging investment in infrastructure and redesigned care processes

The Shared Savings Program will reward ACOs that lower their growth in health care costs while meeting performance standards on quality of care and putting patients first. Participation in an ACO is purely voluntary.