Standing Up the ACO: Lessons from South Park?

By Gregg A. Masters, MPH

On Sunday I was chatting with a friend in the biz and the conversation turned to ACOs, wherein he whimsically laughed and then relayed a story from a recent California Medical Association (CMA) sponsored event on health reform, the future of medicine and Accountable Care Organizations, wherein one of the keynote speaker’s (I suspect Mark Smith, MD, of California Health Care Foundation), queried the audience asking for a show of hands:

How many of you watch South Park?

To wit, an estimated 350 out of 500 hands went in the air (South Park is apparently popular with many physicians). The speaker then recounted the gist of the ‘Gnomes underpants’ episode, analogizing their ‘business plan’ to the current state of the art in the accountable care industry at large (for detailed plot, click here).

The apparent resonance of the narrative is the fitting metaphor of a three phased business strategy [absent the mission critical second phase] to effectively profit from the ill gotten underpants gains’. Some say the ‘accountable care’ development and management glide-path is equally clouded by the absence of a similar mission critical body of knowledge and practice bridging theory with mission fulfillment. Clearly the humor lay in the leap of faith (or invisible hand(s) of the market) required, i.e., now that we formed this ACO thing, what is it we need do to make it profitable? Or in South Park terms, that thing in between acquiring stolen property, and projected assumed profit. Perhaps the context or challenge to organizers of ACOs is best reflected in the oft repeated (and variably credited) refrain:

The accountable care organization is like a unicorn, a fantastic creature that is vested with mythical powers. But no one has actually seen one. – Ian Morrison

Does this accurately reflect the state of ‘accountable care’? While the jury may be out, the empirical data is starting to accumulate. We shall see, and starting in Q1 2013 @ACOwatch will present examples from the broad tapestry of the ACO industry including representatives from the Pioneer class, independent physician led ACOs, their hospital centric alternatives, and hybrid ‘accountable care collaborations’ typically associated if not led by a single or multi payor partner(s).

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