The timing might be right for the Centers for Medicare & Medicaid Services to give hospitals and health systems the go-ahead to crank up their use of value-based care and reimbursement models in some fashion.

It appears that some Medicare accountable care organizations have figured out how to maintain quality and save money, based on new results from the Pioneer Accountable Care Organization program for 2012 and 2013.

A CMS-requested analysis shows that the 32 Pioneer ACOs in the program those years together saved a net $384 million while maintaining quality.

And among the 10 ACOs that were classified as the top-tier savers in the program, the savings totaled $318 million, while among the other 10 considered to be net savers, the total savings was $79 million.

Doing the math, that means 12 ACOs, for whatever reason, statistically didn't produce savings or lost ground during those two years. That's not too surprising given the experimental nature of the ACO approach. Six of the ACOs moved to the Medicare Shared Savings Program and three dropped their Medicare ACOs completely after 2013.

But if the ACOs that are making it work want to expand beyond the parameters of the program, maybe CMS or Congress could figure out a way to let them.

Expansion is certainly in the works at CMS. "This gives CMS greater confidence in scaling elements of the model to benefit people across the nation, and we are working to determine the best strategies for embedding the lessons we have learned from the Pioneer Model into permanent Medicare programs and our nation's health system," said Patrick Conway, M.D., acting principal deputy administrator, in a news release.

But turning that overall Medicare ship will be a slow process. Why not give some of the fast movers freer rein to expand on the approach?

A new, separate analysis of Medicare found that the broader traditional Medicare program (i.e., not Medicare Advantage) is still largely in fee-for-service reimbursement only.

The analysis, led by the employers' group Catalyst for Payment Reform, found that 13.7 percent of traditional Medicare payments were through one of the two Medicare ACO programs. While another 32.8 percent are in a pay-for-performance structure and after some adjustments to avoid double-counting, a sizable 58 percent of payments are made with no value linkage.

"There is tremendous momentum in the Medicare program on payment reform," said Andréa Caballero, program director for CPR. "But we also have to keep in mind that most of these payment methods are still entirely based on fee for service," Caballero said.

"Our next big task is to determine which payment reform methods work best and spread those best approaches," she said.

Hospitals and health system executives in the trenches are in a great position to help speed up that process.