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Pioneer ACO ModelPublic Use Files / Research Identifiable FilesInformation PacketApril 7, 2016Revision: 1.01.05Document Number: RTI.PIONEER.PUFRIF.1.01.05Contact Number: HHSM-500-2014-0037I/HHSM-500-T0001Prepared for:Centers for Medicare & Medicaid Services (CMS)Center for Medicare & Medicaid InnovationSeamless Care Models Group7500 Security Boulevard, N2-13-16Baltimore, MD 21244-1850Prepared by:RTI InternationalPioneer ACO Model PUF/RIF Information PacketRev. 1.01.05
Front MatterRevision 4/2016RevisionsInitial ReleaseCopy editsCorrection of typographical errors in tables 4.1, 4.2 and 4.3Addition of Appendix C. PUF File LayoutChange name of the beneficiary identifier field to BENE ID andrevise definition in tables 5.2 and B.2.2Correction of typographical errors in tables 5.3 and B.3.1Pioneer ACO Model PUF/RIF Information PacketRev. 1.01.05
Front MatterReference documentsDocumentDate¹03/26/2015iiiTitlePioneer ACO Alignment and Financial Reconciliation Methods,(Performance Years 1 through 3, Version 9.1)¹ Methodology.pdfPioneer ACO Model PUF/RIF Information PacketRev. 1.01.05
Front le Care OrganizationACO Program Analysis ContractorCenter for Medicare & Medicaid InnovationCenters for Medicare & Medicaid ServicesIntegrated Data RepositoryPublic Use FileResearch Identifiable FilesPioneer ACO Model PUF/RIF Information PacketRev. 1.01.05
Front MattervTable of ContentsRevision History . iiReference documents . iiiAcronyms . ivTable of Contents . v1.0Introduction . 12.0Data sources and methods . 23.0Definitions . 33.13.43.33.43.53.63.63.74.0Participating Provider . 3Participating Practice . 3Institutional Practice . 3Participating Practitioner . 3Participating Healthcare Facility . 3National Provider Identifier (NPI) . 4CMS Certification Number (CCN) . 4Primary Care Specialist . 4Public Use Files (PUF) . 54.14.24.35.0Participating Provider Data . 5Aligned Beneficiary Data . 5Pioneer ACO Financial Performance Data . 6Research Identifiable Files (RIF) . 85.15.2Participating Provider File . 8Aligned Beneficiary File . 85.2.15.2.25.2.35.2.45.3Incurred and paid parameters for performance year expenditure . 9Definition of “at-risk” expenditure in 1st performance year . 10Definition of “at-risk” expenditure in 2nd performance year . 10Definition of “at-risk” expenditure in 3rd performance year . 10Pioneer ACO Financial Performance File . 11Appendix A. Provider Specialty Codes . 13Appendix B. RIF File Layouts . 14B.1B.2B.3Provider RIF . 14Beneficiary RIF. 14Financial RIF . 16Appendix C. PUF File Layout . 18Pioneer ACO Model PUF/RIF Information PacketRev. 1.01.05
1.0Introduction1.0Introduction1The Public Use Files (PUF) and Research Identifiable Files (RIF) provide basic data that will enableresearch and policy analysts to conduct analysis of the experience and performance of participants inthe Pioneer Accountable Care Organization (ACO) Model.The PUF and RIF each consists of three data files for each performance year.1. Data on Participating Providers2. Data on Aligned Beneficiaries3. Data on ACO Financial PerformanceThe PUF contains summarized data on Participating Providers and Aligned Beneficiaries. The RIFcontains data that identify individual providers and beneficiaries.Pioneer ACO Model PUF/RIF Information PacketRev. 1.01.05
2.0Data sources and methods2.0Data sources and methods2The data used to create the PUF and RIF were obtained from several sources.Participating Provider Data were obtained from the data submitted by Pioneer ACOs to CMMI andprocessed by the ACO Program Analysis Contractor (ACOPAC).Beneficiary data, including data on the alignment of individual beneficiaries to Pioneer ACOs anddemographic characteristics were obtained from the CMS Integrated Data Repository (IDR).Expenditure data were obtained from the IDR.Financial performance data were obtained from records maintained by the ACOPAC. Financialperformance data, including baseline expenditures, expenditure benchmarks, and performance-yearexpenditures are created from data obtained from the IDR. Quality scores are created by the ACOPACfrom data obtained from the IDR or submitted by the Pioneer ACOs.Pioneer ACO Model PUF/RIF Information PacketRev. 1.01.05
3.0Definitions3.0Definitions3.1Participating Provider3A Pioneer ACO Participating Provider (also referred to as a Participant) is either:1. A physician or non-physician practitioner; or2. A facility or institutional provider.A Participating Provider who is a practitioner is identified as a Participating Provider by the combinationof the identifier for a Participating Practice and the identifier for a Participating Practitioner.3.4Participating PracticeA Participating Practice is:1.2.3.4.A “private” physician practice;A Federally Qualified Health Center (FQHC);A Rural Health Clinic (RHC); or,A Critical Access Hospital that elects payment under Method 2 (CAH2).A participating physician practice is identified by a Taxpayer Identification Number (TIN).An FQHC, RHC, or CAH2 practice is identified by TIN, CMS Certification Number (CCN), and anorganizational NPI.3.3Institutional PracticeAn Institutional Practice is a Federally Qualified Health Center (FQHC), a Rural Health Clinic (RHC), or aCritical Access Hospital that elects payment under Method 2 (CAH2).3.4Participating PractitionerA Participating Practitioner is a physician or non-physician practitioner (NPP) identified by an individualNational Provider Identifier (NPI) who is a member of a participating practice. A practitioner may be amember of more than one practice and may participate in more than one Pioneer ACO.3.5Participating Healthcare FacilityA Participating Healthcare Facility is an institutional provider. Examples of Participating HealthcareFacilities include but are not limited to: acute care hospitals, skilled nursing facilities (and units of acutehospitals including swing-beds), home health agencies, hospices, federally qualified health centers, ruralhealth clinics, critical access hospitals, inpatient rehabilitation facilities, outpatient rehabilitationfacilities, long-term care hospitals, psychiatric hospitals (and units of acute hospitals), dialysis facilities,and ambulatory surgical facilities.Pioneer ACO Model PUF/RIF Information PacketRev. 1.01.05
3.0Definitions3.6National Provider Identifier (NPI)4The unique 10-character code issued by the National Plan and Provider Enumeration System (NPPES)that is used to identify either an organization or an individual on claims and other electronictransactions.An Organization NPI identifies a facility or other organization such as a hospital, nursing facility, homehealth agency, dialysis facility, or physician practice.An Individual NPI identifies an individual practitioner (i.e., a physician or non-physician practitioner suchas a physician assistant).3.6CMS Certification Number (CCN)A 6-character code issued by CMS when an institutional provide applies to become Medicareparticipating provider.3.7Primary Care SpecialistA primary care specialist is: A physician specializing in General Practice, Family Medicine, Internal Medicine, Geriatric Medicine;A Nurse Practitioner; orA Physician AssistantPioneer ACO Model PUF/RIF Information PacketRev. 1.01.05
4.0Public Use Files (PUF)4.0Public Use Files (PUF)4.1Participating Provider Data5The Participating Provider data included in the PUF consists of the fields or variables described in Table4.1.Table 4.1. Data on Participating Providers included in the PUFFieldDescriptionACO IDUnique identifier of the Pioneer ACOCMMI NAMEName of the Pioneer ACOPRVDR CTNumber of participating providers¹PRAC CTTotal number of physician practices²PROF PRAC CTTotal number of non-institutional physician practices³INST PRAC CTNumber of institutional physician practices⁴PROF PRVDR CT Number of professional providers⁵PAR FAC CTTotal number of participating health care facilities⁶PCP PRVDR CTNumber of participating primary care specialists⁷¹ A participating provider in the Pioneer ACO Model is defined as either an institutional provider (see footnote 2) identified by an organizationNPI or a health care practitioner at a participating practice identified by a combination of a practice identifier (a TIN or CCN) and apractitioner identifier (the individual NPI).² The number of participating institutional and non-institutional (“private”) physician practices.³ The number of participating non-institutional (“private”) physician practices.⁴ The number of participating institutional physician practices.⁵ The number of participating providers not including participating health care facilities⁶ The number of participating health care facilities that are not institutional physician practices.⁷ The number of participating providers who are primary care specialists. (Not reported for PY1)4.2Aligned Beneficiary DataThe Aligned Beneficiary data included in the PUF consists of the fields or variables described in Table 3.2.Table 4.2. Data on Aligned Beneficiaries included in the PUFFieldDescriptionACO IDThe identifier of the Pioneer ACO with which the beneficiary is alignedALGN COUNTThe total number of performance-year aligned beneficiariesAGED COUNTThe number of performance-year aligned beneficiaries who were classified asAged under the Pioneer ACO Model Benchmarking methodDISABLED COUNTThe number of performance-year aligned beneficiaries who were classified asAged under the Pioneer ACO Model Benchmarking methodESRD COUNTThe number of performance-year aligned beneficiaries who were classified asAged under the Pioneer ACO Model Benchmarking methodMALE COUNTThe number of performance-year aligned beneficiaries who were maleFEMALE COUNTThe number of performance-year aligned beneficiaries who were femaleAGE LT65 COUNTThe number of performance-year aligned beneficiaries who were classified asunder age 65 in the Pioneer ACO Model Benchmarking methodAGE 6569 COUNT The number of performance-year aligned beneficiaries who were classified as65 to 69 years of age in the Pioneer ACO Model Benchmarking methodPioneer ACO Model PUF/RIF Information PacketRev. 1.01.05
4.0Public Use Files (PUF)FieldAGE 7079 COUNTAGE GE80EXP TOTEXP NCH10EXP NCH20EXP NCH30EXP NCH40EXP NCH50EXP NCH60EXP NCH71EXP NCH72EXP NCH81EXP NCH826DescriptionThe number of performance-year aligned beneficiaries who were classified as70 to 79 years of age in the Pioneer ACO Model Benchmarking methodThe number of performance-year aligned beneficiaries who were classified as80 years of age or older in the Pioneer ACO Model Benchmarking methodTotal expenditure for all claim typesTotal expenditure for home health agency services (NCH claim type 10)¹Total expenditure for SNF services (NCH claim type 20)¹Total expenditure for SNF/Swing-bed services (NCH claim type 30)¹Total expenditure for outpatient services (NCH claim type 40)¹Total expenditure for hospice services (NCH claim type 50)¹Total expenditure for inpatient services (NCH claim type 60)¹Total expenditure for physician non-DMEPOS services (NCH claim type 71)¹Total expenditure for DMEPOS services non-DMAC (NCH claim type 72)¹Total expenditure for DMEPOS services DMAC (NCH claim type 81)¹Total expenditure for non-DMEPOS services DMAC (NCH claim type 82)¹¹ See table 5.2.1 for incurred and paid parameters. All expenditure fields are expenditures incurred in the performance year.4.3Pioneer ACO Financial Performance DataThe Pioneer ACO financial performance data included in the PUF consists of the fields or variablesdescribed in Table 3.3.Table 4.3. Content of Financial Performance RIFFieldDescriptionACO IDThe Pioneer ACO identifierSTLMNT DTA reference date identifying the financial settlement (CCYYMMDD)ALGND BENE CTThe number of beneficiaries aligned with the Pioneer ACO in the yearend financial settlementALGND BENE MNTHSThe number of person-months accrued during the performance-year bythe beneficiaries aligned with the Pioneer ACOACO BASELINE PBPYThe Pioneer ACO baseline expenditure¹ expressed on a per-beneficiaryper-year (PBPY) basis²ADJ REF BASELINE PBPY The adjusted reference baseline¹ for the Pioneer ACO expressed on aPBPY basis²ADJ REF PERFYEAR PBPY The adjusted reference performance-year expenditure¹ for the PioneerACO expressed on a PBPY basis²REF PBPY CHNGThe difference between the adjusted reference baseline and the adjustedreference performance-year expenditure for the Pioneer ACOREF PBPY TRNDThe ratio of the difference between the adjusted reference baseline andthe adjusted reference performance-year reference to the adjustedreference baseline for the Pioneer ACOACO PBPY TRND CMPNT The product of the adjusted reference trend (REF PBPY TRND) and theACO baselineACO BLND PBPY INCRThe simple average of the change in the adjusted reference expenditure(REF PBPY CHNG) and the product of the adjusted reference trend andthe ACO baseline (ACO PBPY TRND CMPNT)Pioneer ACO Model PUF/RIF Information PacketRev. 1.01.05
4.0Public Use Files (PUF)FieldACO BNMRK PBPYACO PERFYEAR PBPYGROSS SAVINGS PBPYBNCHMRK EXPENDACO PERFYEAR EXPNDGROSS SAVINGSPERFYEAR QUAL SCREQLTY ADJ SSL RATESHARED SAVINGSBNCH MTHDAWI GPCI ADJRISK ARNGMNTMSR7DescriptionThe ACO expenditure benchmark¹ expressed on a PBPY basis²The performance-year expenditure¹ of the Pioneer ACO expressed on aPBPY basis²The difference between the ACO benchmark and the ACO performanceyear expenditure¹ expressed on a PBPY basis²The aggregate expenditure benchmark¹ for the Pioneer ACO, equal to theproduct of ACO BNMRK PBPY and the aligned beneficiary personmonths that accrued during the performance-yearThe aggregate performance-year expenditure¹ of the Pioneer ACOThe difference between the aggregate expenditure benchmark and theperformance-year expenditure¹ of the Pioneer ACOThe quality score attained by the Pioneer ACO in the performance yearThe quality adjusted shared savings (or shared loss) rate of the PioneerACOThe shared savings (or loss) of the Pioneer ACO, equal to the product ofthe gross savings and the quality adjusted shared savings rateThe variant of the Pioneer benchmarking method elected by the PioneerACO in the performance yearThe Area Wage Index/Geographic Practice Cost Index adjustmentapplicable to the Pioneer ACO in the performance yearThe risk sharing arrangement selected by the Pioneer ACO in theperformance yearThe minimum savings rate selected by the Pioneer ACO for theperformance year under its risk arrangement¹ Baseline and performance year expenditures may be either capped or uncapped as specified in the Pioneer ACO agreement.² See discussion of units of measurement.Pioneer ACO Model PUF/RIF Information PacketRev. 1.01.05
5.0Research Identifiable Files (RIF)5.0Research Identifiable Files (RIF)8The Research Identifiable Files (RIF) contain beneficiary-level and provider-level data for the alignedbeneficiaries and participating providers of each Pioneer ACO. These data allow an analyst to obtainadditional data (by providing beneficiary and provider identifiers) to facilitate analysis of the impact ofthe ACO on expenditures and utilization. They also include data that facilitate linkage to the year-endfinancial settlement of the Pioneer ACO.5.1Participating Provider FileThe RIF Participating Provider data includes the 10 fields or variables described in Table 4.1.Table 5.1. Content of Participating Provider RIFFieldDescriptionACO IDUnique identifier of the Pioneer ACOACO NAMEName of the Pioneer ACOPRVDR TYPEAn indicator of whether the provider record identifies an institution or aprofessional.PRVDR TINThe taxpayer identification number (TIN) of the participating provider, generally anemployer identification number but may be (in the case of professionals) a socialsecurity number.TIN NAMELegal name associated with the TIN.PRVDR NPIThe National Provider Identifier (NPI) for an individual (in the case of a record for aprofessional) or an organization (in the case of a record for an institution)PRVDR CCNThe CMS Certification Number of an institutional provider (when applicable andavailable)NPI NAMELegal Name associated with the NPI. In the case of professionals, the NPI name isthe last and first name of the professional. In the case of institutions, the NPI nameis the name of the institution.PRVDR SPCLTY An indicator of whether the provider was considered a primary care specialist forpurposes of applying exclusivity rulesZIP CDThe zip code in which the provider principally practices (when applicable andavailable)5.2Aligned Beneficiary FileThe RIF Aligned Beneficiary data includes the fields or variables described in Table 5.2. The data onaligned beneficiaries have two primary purposes: (1) to serve as a finder file; and (2) to provide data thatare required by the Pioneer benchmarking method. Four types of data are included.1. Beneficiary identifier, Pioneer ACO alignment, and alignment eligibility data2. Beneficiary demographic characteristicsPioneer ACO Model PUF/RIF Information PacketRev. 1.01.05
5.0Research Identifiable Files (RIF)9Table 5.2. Content of Beneficiary RIFFieldDescriptionBENE IDA unique CCW beneficiary identifier field (BENE ID) that is specific to the ChronicCondition Warehouse. This field is encrypted prior to delivery. The BENE ID fieldis used to cross-reference data for each beneficiary across all claim andassessment data files.ACO IDThe identifier of the Pioneer ACO with which the beneficiary is alignedELIG CATAn indicator of whether the beneficiary was classified as Aged (A), Disabled (D), orESRD (E) in the Pioneer benchmarking methodEAS CATA four-character field identifying the specific eligibility-age-sex stratum to whichthe beneficiary was assigned in the Pioneer benchmarking method consisting of acharacter for the eligibility category, a character for beneficiary sex, and twocharacters giving the lower bound of the age category to which the beneficiary isassigned.SEXMale (M) or Female (F)DOBDate of birthDODDate of deathALGN ELIG 2009 Beneficiary was eligible for alignment to a Pioneer ACO in CY2011ALGN ELIG 2010 Beneficiary was eligible for alignment to a Pioneer ACO in CY2011ALGN ELIG 2011 Beneficiary was eligible for alignment to a Pioneer ACO in CY2011ALGN ELIG 2012 Beneficiary was eligible for alignment to a Pioneer ACO in CY2012²ALGN ELIG 2013 Beneficiary was eligible for alignment to a Pioneer ACO in CY2013³BENE CTY CDSSA 5-character county code for the beneficiary’s county-of-residence in Januaryof the performance yearEXP NCH10Total expenditure for home health agency services (NCH claim type 10)¹EXP NCH20Total expenditure for SNF services (NCH claim type 20)¹EXP NCH30Total expenditure for SNF/Swing-bed services (NCH claim type 30)¹EXP NCH40Total expenditure for outpatient services (NCH claim type 40)¹EXP NCH50Total expenditure for hospice services (NCH claim type 50)¹EXP NCH60Total expenditure for inpatient services (NCH claim type 60)¹EXP NCH71Total expenditure for physician non-DMEPOS services (NCH claim type 71)¹EXP NCH72Total expenditure for DMEPOS services non-DMAC (NCH claim type 72)¹EXP NCH81Total expenditure for DMEPOS services DMAC (NCH claim type 81)¹EXP NCH82Total expenditure for non-DMEPOS services DMAC (NCH claim type 82)¹¹ See table 5.2.1 for incurred and paid parameters. All expenditure fields are expenditures incurred in the performance year.² Available only for beneficiaries aligned in PY2.³ Available only for beneficiaries aligned in PY35.2.1Incurred and paid parameters for performance year expenditureThe total expenditure that is reported for each beneficiary is the expenditure for covered servicesincurred during the performance-year and paid within three months of the end of the performanceyear. (See table 5.2.1.) The total expenditure for which a Pioneer ACO is at risk is calculated differently ineach performance year.Pioneer ACO Model PUF/RIF Information PacketRev. 1.01.05
5.0Research Identifiable Files (RIF)10Table 5.2.1. Incurred and paid parameter for performance year expenditurePerformance Year Claim incurred dateClaim paid datePY1/CY201201/01/2012 through 12/31/2012, inclusivePrior to 04/01/2013PY2/CY201301/01/2013 through 12/31/2013, inclusivePrior to 04/01/2014PY3/CY201401/01/2014 through 12/31/2014, inclusivePrior to 04/01/20155.2.2Definition of “at-risk” expenditure in 1st performance yearIn PY1/CY2012, the total expenditure for which a Pioneer ACO is at risk in both the base andperformance year is simply amount paid to the provider of service on claims for covered services.5.2.3Definition of “at-risk” expenditure in 2nd performance yearIn PY2/CY2013, the total expenditure for which a Pioneer ACO is at-risk in the performance year:1.2.3.4.The amount paid to the provider of service on claims for covered services;PLUS: The budget sequestration amount withheld from the provider payment;LESS: The uncompensated care payment amount on inpatient claims; and,PLUS: The population-based-payment (PBP) reduction (if any) made to the provider payment.In PY2/CY2013, the total expenditure for which a Pioneer ACO at-risk in the base year:1.2.3.4.The amount paid to the provider of service on claims for covered services;PLUS: The budget sequestration amount withheld from the provider payment;LESS: The uncompensated care payment amount on inpatient claims;LESS: 75% of the operating disproportionate share hospital payment on inpatient claimsincurred prior to October 1 of the year; and,5. PLUS: The population-based-payment (PBP) reduction (if any) made to the provider payment.5.2.4Definition of “at-risk” expenditure in 3rd performance yearIn PY3/CY2014, the total expenditure for which a Pioneer ACO is at-risk in the performance year:1.2.3.4.The amount paid to the provider of service on claims for covered services;PLUS: The budget sequestration amount withheld from the provider payment;LESS: The uncompensated care payment amount on inpatient claims; and,PLUS: The population-based-payment (PBP) reduction (if any) made to the provider payment.In PY3/CY2014, the total expenditure for which a Pioneer ACO is at-risk in the base year:1.2.3.4.The amount paid to the provider of service on claims for covered services;PLUS: The budget sequestration amount withheld from the provider payment;LESS: The uncompensated care payment amount on inpatient claims;LESS: 75% of the operating disproportionate share hospital payment on inpatient claimsincurred in any month of the year (for claims incurred prior to CY2013) or incurred prior toOctober 1, 2013 (for claims incurred during CY2013); and,Pioneer ACO Model PUF/RIF Information PacketRev. 1.01.05
5.0Research Identifiable Files (RIF)115. PLUS: The population-based-payment (PBP) reduction (if any) made to the provider payment.Under the Pioneer ACO Model, the expenditure included in a base or performance year is developedusing the so-called “debit/credit” method. It does not use the so-called “final action” method. Under the“final action” method, the total expenditure incurred by a beneficiary is the sum of the payment amounton all claims that as of the end of the run-out period for the calendar year represented the last or “final”action taken on a claim incurred during the calendar year. Under the debit/credit method theexpenditure is the sum of all claim transactions, including original claims, cancellation claims, andadjustment claims that were processed prior to the end of the run-out period for the calendar year. Theincurred date for a claim is the through date on the claim header (in the case of claim types 10 through60) and the through date on the claim line-item (in the case of claim types 71, 72, 81 and 82). The paiddate is the NCH weekly processing date (also referred to as the claim effective date).5.3Pioneer ACO Financial Performance FileThe Pioneer ACO Financial Performance File contains the basic data for the performance year financialsettlement. It includes the 27 fields described in table 5.3.Table 5.3. Content of Financial Performance RIFFieldDescriptionPERF YEARThe performance year to which the settlement data applySTLMNT DTA reference date identifying the financial settlement (CCYYMMDD)ACO IDThe Pioneer ACO identifierPIONEER NAMEShort name of the Pioneer ACOALGND BENE CTThe number of beneficiaries aligned with the Pioneer ACO in the yearend financial settlementALGND BENE MNTHSThe number of person-months accrued during the performance-year bythe beneficiaries aligned with the Pioneer ACOACO BASELINE PBPYThe Pioneer ACO baseline expenditure¹ expressed on a per-beneficiaryper-year (PBPY) basis²ADJ REF BASELINE PBPY The adjusted reference baseline¹ for the Pioneer ACO expressed on aPBPY basis²ADJ REF PERFYEAR PBPY The adjusted reference performance-year expenditure¹ for the PioneerACO expressed on a PBPY basis²REF PBPY CHNGThe difference between the adjusted reference baseline and the adjustedreference performance-year expenditure for the Pioneer ACOREF PBPY TRNDThe ratio of the difference between the adjusted reference baseline andthe adjusted reference performance-year reference to the adjustedreference baseline for the Pioneer ACOACO PBPY TRND CMPNT The product of the adjusted reference trend (REF PBPY TRND) and theACO baselineACO BLND PBPY INCRThe simple average of the change in the adjusted reference expenditure(REF PBPY CHNG) and the product of the adjusted reference trend andthe ACO baseline (ACO PBPY TRND CMPNT)ACO BNMRK PBPYThe ACO expenditure benchmark¹ expressed on a PBPY basis²Pioneer ACO Model PUF/RIF Information PacketRev. 1.01.05
5.0Research Identifiable Files (RIF)FieldACO PERFYEAR PBPYGROSS SAVINGS PBPYBNCHMRK EXPENDACO PERFYEAR EXPNDGROSS SAVINGSPERFYEAR QUAL SCREQLTY ADJ SSL RATESHARED SAVINGSBNCH MTHDAWI GPCI ADJRISK ARNGMNTMSR12DescriptionThe performance-year expenditure¹ of the Pioneer ACO expressed on aPBPY basis²The difference between the ACO benchmark and the ACO performanceyear expenditure¹ expressed on a PBPY basis²The aggregate expenditure benchmark¹ for the Pioneer ACO, equal to theproduct of ACO BNMRK PBPY and the aligned beneficiary personmonths that accrued during the performance-yearThe aggregate performance-year expenditure¹ of the Pioneer ACOThe difference between the aggregate expenditure benchmark and theperformance-year expenditure¹ of the Pioneer ACOThe quality score attained by the Pioneer ACO in the performance
Pioneer ACO Model PUF/RIF Information Packet Rev. 1.01.05 Pioneer ACO Model Public Use Files / Research Identifiable Files Information Packet April 7 , 201 6 Revision: 1.01.0 5 Document Number: RTI.PIONEER.PUFRIF .1.01.05 Contact Number: HHSM -500 -2014 -0037I/HHSM -500 -T0001 Prepared for: Centers for Medicare & Medicaid Services (CMS)
