The Medicare Shared Savings Program: Class of 2015

By Gregg A. Masters, MPH

The clock is ticking and the CMS continues its community outreach via their series of National Provider Calls on the application process for ACOs interested in submitting for the Medicare Shared Savings Program.Medicare Shared Savings Program

The deadline for the class of 2015 is approaching with the next call scheduled for Tuesday, April 22nd 2014 from 1;30 – 3PM Eastern.

You can register for this call here.

Space is limited and demand for these calls often exceed available slots, so get your registration in early.

Meanwhile, the description of the program is as follows:

During this MLN Connects™ National Provider Call, CMS subject matter experts cover helpful tips on completing a successful application, including information on how to submit an acceptable ACO Participant List, Sample ACO Participant Agreement, Executed ACO Participant Agreements, and Governing Body Template for the Medicare Shared Savings Program application. A question and answer session follow the presentation.

The Shared Savings Program Application web page has important information, dates, and materials on the application process. Call participants are encouraged to review the application and other materials found on this web page prior to the call.

Target Audience

Potential 2015 ACO Applicants

Presentation

The presentation for this call will be posted at least one day in advance of the call on the MLN Connects™ National Provider Calls and Events web page. Select the call date and scroll to the “Call Materials” section to locate the slide presentation. A link to the audio recording and written transcript of this call will be posted under the “Calls Materials” section in approximately 2 weeks following the call.

Registration will close at 12:00 p.m. ET on the day of the call or when available space has been filled.

Patient Engagement in an ACO World

By Gregg A. Masters, MPH

Last June I had the honor or moderating a panel on ‘unlocking innovation in patient engagement’ in an ACO World at MedCity News’s ENGAGE conference. Joining me on the panel are: Libby Webb, Director, Product Management, Athenahealth, Lanie W. Abbott, APR, Senior Communications & Outreach Coordinator, EMHS Population Health Management and Colin Ward, MHS, Executive Director, Greater Baltimore Health Alliance.

During the session we discuss ACO implementation issues and how early movers are mobilizing and organizing to drive sustained patient engagement while conforming to a complicated set of ACO policies. Patient engagement will continue to be the missing link in new value-based reimbursement programs until the quality of patient communications leads to consistent behavior. We discuss how new ACOs are investing in benchmarking tools and communications interventions that will measurably improve the quality of physician-patient communication.

More than Half of ACOs ‘Save Money’ Only 1/4 Bonus Providers

By Gregg A. Masters, MPH

In the narrative matters department and following CMS’s press release on January 30th, 2014 of the ‘interim financial results for select Medicare Accountable Care Organization (ACO) initiatives, an in-depth savings analysis for Pioneer ACOs, results from the Physician Group Practice demonstration, and expanded participation in the Bundled Payments for Care Improvement Initiative’ several downstream headlines are instructive in this continuing battle for the hearts and minds of the American public towards the Affordable Care Act.

Physician Standing Up the ACOOver at Healthcare IT News, Bernie Monegain, Editor chimes in via: ‘More than half of ACOs show savings: Accountable care organizations are helped by the use of health information technology.’

While at Kaiser Health News staff writer Jenny Gold notes: ‘ACOs Saving Some Money, But Medicare Is Short On Details.’

And Melanie Evans at Modern Healthcare asserts ‘Providers net uneven results from ACO experiment‘ re-capping the data as follows:

Slightly more than half of the 114 organizations to join one of two Medicare accountable care efforts in 2012 did not reduce health spending below targets during their first 12 months trying to do so, newly released CMS data show. 

Of the remaining organizations, 29 reduced spending enough to keep some of what they saved during the first 12 months. The rest slowed health spending, but marginally. 

Take your pick, there are plenty more to chose from and whether your view is from a glass ‘half empty’ or ‘half full’ perspective your answer to whether the ACA is working or not, and in particular, can ACOs enable the required transformation is likely to be shaped by whether you have a dog in the hunt if not personal skin in the game.

To sort through and make some sense of this nascent industry ‘report card’ are three industry veterans who will help us dive past the headlines and into the weeds of the ACO experience. Recognizing that ACOs not a homogeneous bunch and vary operationally and by market, there is a fair amount of context setting to actually interpret the results.

On the next episode of ‘This Week in Accountable Care‘ I am joined by three seasoned players in and around the space including Fred Goldstein, Jim Hansen and David Crais.

For live or archived replay of this episode, click here.

Join us for an informative chat and tag your tweets with #ACOchat and will put your questions and/or comments into the conversation.

It’s All About the Network

By Gregg A. Masters, MPH

2014 has kicked off to a challenging pace and doesn’t look to let up any time soon!

Over at Health Innovation Media where we follow health innovation from ‘idea to business model’ including accountable care platforms, ‘apps’ or infrastructure plays,  Dr. Pat Salber, co-founder at Health Innovation Media, CEO of early mover in the ‘rewards based’ crowd funding and innovation challenge space HealthTech Hatch and curator of The Doctor Weighs In and me are in workflow overflow from the mHealth Summit 2013 in National Harbor, VA.

If that wasn’t enough of a stretch for our new media startup, we just concluded the better part of the week in Las Vegas covering digital health developments at CES 2014 (see: Amidst the CES 2014 Firehose: Brands, Blogs & ‘PR’ Compete for Relevance in the Digital Economy) and it’s internally nested ‘Digital Health Summit‘, only to return to California challenged by the depth and breadth of the proceedings from both the JP Morgan Healthcare Conference and lesser known OneMed Forum.

One vetted message with relevant context to accountable care and the associated quest for the triple aim is sourced from the above JP Morgan Healthcare conference. The inspiration for this post’s headline and specifically it’s inherent ‘managed competition’ wisdom is courtesy of the CEO of the most ‘transformational ACO payor partner‘ – at least from the point of view of KLAS‘s ‘Accountable Care Payers: Partners in a Changing Paradigm‘. That player is Aetna or perhaps an attribution more holistically made to the aggregate activities of it’s fire-walled innovation sub Healthagen.

JPM14 KLAS transformer recognition

In his talk Mark Bertolini Aetna Chairman, President & CEO a man who’s career was forged squarely in the belly of HMO culture inside a traditional service vs. indemnity play,  via a rust belt domiciled ‘Blue plan’ competitor lays out the challenge not just for Aetna, but anyone in the accountable care space whether payor, provider or hybrids intent upon the co-creation of a sustainable future.

(NOTE: The entire series of JP Morgan webcasts including decks (where supplied) are accessible here. You’ll  need provide your email for a one time registration process to access all sessions, but the benefits are well worth it).

Back to Bertolini’s message, here are some note-able quotes from a very insightful and smart senior executive who sets the transformational imperative as follows:

This is how people feel about the healthcare system, it was designed in 1945 after WW2. It was funded by Hill Burton, and not much has changed over that time period in the way we run our healthcare system.

We leave the consumer to try and find their way through the system without much information, without much transparency.

So our goal is to change the system to align the incentives on the provider side [with the payor], give the consumers the tools so these questions can be answered and they can find a direct line of sight about how to use healthcare.

Our view is the system should work around the member, that it should be all about the member and  that it should be a personalized experience where all of these issues come together in one way… [i.e., the triple aim]

JPM14 Aetna healthier world

‘Line of sight’ what?

Heresy one might say from a once ‘all in’ little-to-no copay access to comprehensive health benefits HMO guy to now espouse a role for a marquee health plan operator to drive ecosystem integration between a tech enabled but evolving retail medicine (aka consumer directed or high deductible health plan world) segment and the costly, inflated, siloed and opaque sick care non-system.

But there’s more as the story is not so simple, nor easily analogized.

Bertolini continues and goes to the fundamental drivers of the Affordable Care Act and the enabling ACOs, ‘accountable care arrangements’ or their derivative plays that will ‘chop the wood and carry the water’ of this unprecedented transformation of a WW2 vintage legacy paradigm on life support.

If you’ve seen one ACO, you’ve seen one ACO, we do not call all of our value based contracting an ACO.

We have 100′s of value based contracting arrangements and various incentive programs in place, but for us, an ACO is an enabled provider network that’s at risk with us to improve the overall outcome for the patient and get rewarded as a result of making that happen.

Branded health plans is the next step [in the KLAS continuum noted above] and our most recent relationship with Inova we have launched Innovation Health Plans which is a branded private product of the Inova Health System in Northern Virginia.

This whole idea is to create transformational relationships with providers that let them be in the business of providing health plans to their community, allow them to change their revenue model by enrolling their patients and getting [Aetna] out of the middle of that relationship. We provide the risk mechanism, the technology and the intellectual property to allow it to happen, and that is what our ACO model is.

Bertolini then pivots to adding value in this expanding ‘retail’ market where Aetna enables informed choice via tools that empower members with the requisite ‘line of sight’ and thus gain share given projected enrollment of 75 million by 2020.

JPM14 Aetna retail projections

May I say, with the posting of this strategic glidepath the pivot of Aetna as a proxy for the legacy carrier health insurance business (including their forays into the HMO business) comes to an end. Rather re-skinned PPO’s, POS’s, and OWA’s morphed into ACOs of varying stripes intent upon passing increasing ‘skin in the game’ exposure to their members or insureds to vote with their feet and thus pocketbooks is now permanently enshrined as the defacto standard of ‘health insurance’ (whether ASO, fully or now retail/exchange based) in the U.S.

In this new model, health plans will morph into ‘utility companies’ who’s core competencies will center or transactional efficiency, member empowerment (to promote informed line of sight choices) and ecosystem stakeholder homeostasis largely as benefit solutions providers more and more with local or regional provider co-branding and sponsorship DNA.

Don’t get me wrong, I respect Mark and his chief architect Chuck Saunders, MD who’s assembling these consumer, informational and transactional empowerment capabilities inside the Aetna mothership via a ‘fire-walled’ Healthagen. From MediCity to iTriage and Active Health, this is precisely what the new zeitgeist requires of the legacy health insurance business.

Lets just call it as it is, AHIP and it’s member partners (principally the Health Insurance Association of America/HIAA constituency, exclusive of the Group Health Association of America/GHAA contingent) have failed at managing clinical risk and have effectively thrown in the towel, i.e., managed care was never more than mere contracting for discounted pricing, as armies of medical directors rarely denied more than 1% of referrals and/or admissions.

So today, surprise, surprise, it’s all about the network – as in ‘high value networks’ – tighter, smaller value based clusters of high performing provider collaborations.

Again, this is a fabulous pitch by Bertolini and one I highly recommend you listen to in it’s entirety.

Next up similar insights from AthenaHealth CEO Jonathan Bush followed by a somewhat anemic if not apologetic performance of Universal American’s CEO I’ll title ‘a not so healthy collaboration.’

As always, your thoughts, opinions or challenges are welcome.

Accountable Care, mhealth and the Triple Aim

By Gregg A. Masters, MPH

For those of you following this blog you know I write about ACOs and the emerging accountable care zeitgeist. My lens has been forged by decades of experience in the ‘managed competition’ experiment. For an earlier piece see: Some Context and Perspective on Standing Up the ACO.’ HCFA masthead

The managed competition industry – perhaps more widely known as ‘managed [though more accurately mangled] care’ – can be traced back to it’s regulatory oversight origins via an office in the predecessor agency to CMS, the Health Care Financing Administration (HCFA) titled the ‘Office of Alternative Delivery Systems’ (OADS).

The mission of the OADS was to monitor the then emerging (‘disruptive’) players in the HMO domain but also this little known but ‘HMO lite’ mutation dubbed ‘preferred provider organizations’ (PPOs). The alternative delivery system domain was typically populated by those operators who compensated their contracted network of physicians, hospitals and ancillary providers via other than routine fee for services based payment. Alternative compensation ranged from mere discounts of standard fee schedules to full or partial capitation for physician or even hospital services, thus ADS operators could be arrayed across a continuum of risk assumption.

It is interesting to note that what was then considered ‘alternative’ to prevailing or normalized healthcare financing and delivery is now the new ‘normal’. Yet, we hear more reference to ‘alternative delivery systems’ today as representative by such new age/zeigeist disruptors the likes of certain ACOs, medical homes or even the tapestry of direct, membership, retainer or even ‘concierge’ models of delivery – including hybrids (OneMedical).

So in a way, the first phase of the ‘integration 1.0′ cycle is complete and we’re now embarking on ‘integration 2.0′ using the same terms albeit applied to different vehicles. Instead of HMOs or PPOs, we’re talking about ACOs, medical homes or other care delivery innovations.

Clearly technology – both enterprise and consumer facing – are central to the complex deliverable of the sustainable healthcare ecosystem, yet the preferred ‘chassis’ onto which to stitch if not graft the organizational, governance and operational best practices remain somewhat elusive.  To many digital or mhealth enabled solutions seems to represent a fair amount of rational promise to emerging ACOs.

At the 5th Annual mhealth Summit in a session titled: ‘Mobile Enabling the ACO‘ we’ll here from:

…on the state of the merger between promising digital health technologies and ACO operational fulfillment of certain ACA performance requirements .

The session description and schedule is pasted below:

mobile enabling of ACO

ACA, Accountable Care and the @HealthcareGov Fiasco

By Gregg A. Masters, MPH

With the quiet time afforded this ‘Thanks Giving-Kah’, I feel called to express some ‘dis-ease’ with the progress towards our pursuit of the triple aim or sustainable healthcare ecosystem.

healthcareGov cartoon

As if the health reform battle hasn’t been a power partisan exchange from day one. Think again…

If you weren’t paying attention during the run up to the Act’s passage in March of 2010, be reminded that the process was NOT imbued with the goodwill and fair consideration of grounded health policy arguments – both pro and con – to vet what might emerge from our bi-cameral legislative process and stand in the marketplace of ‘workable reform’.

But who among us could have predicted that health information technology performance or more accurately the lack of said ‘e-commerce performance’ might emerge as the likely candidate fulfilling the oppositions’ intent to stand in the way of ‘real’ health insurance for some 75 millions Americans?

Seriously HealthIT as the tipping point in the demise of the Act? Who saw that? As noted by a colleague on twitter:

Margalit Gur-Arie ‏@margalitgurarie 20 Nov
@2healthguru Oh yeah If someone said a year ago that Obamacare will fail on account of technology, I would have laughed them out of the room

In the midst of 46 attempts by the Republican controlled House to defund or repeal the ACA, a tapestry of lawsuits filed by AGs in ‘red states’, an unexpected SCOTUS affirmation of the law coupled with ‘discretionary’ state participation in the Medicaid expansion provision, and relentless Tea Party backed efforts to tag the Act as the end of freedom itself and the institutional permanence of ‘big government’ in the lives of all Americans – what most failed to appreciate is the market based nature of the effort. Health reform and the provisions in the Act express macro trends deeply rooted in the connective tissue of provider/payor/patient/consumer marketplace experience, wholly independent of the exquisitely orchestrated though faux political narrative – the crown jewel in the playbook of ‘weapons of mass deception’.

I have been in the ‘managed competition’ side of this business for 3+ decades and often can’t understand the nature of the beast we’ve created. The ‘healthcare conundrum‘ so aptly coined by Atul Gawande quite some time ago is a complex and unwieldy beast I have affectionately tagged the ‘healthcare borg‘ as a reference to the ‘resistance [as in change] is futile’ reference in Star Trek. Yet, many who lack even an undergraduate grasp on the nature of the American sick-care economy are unreasonably certain in their opinions on the nature of the malady and what might pass as proper remedies. Unfortunately, this certainty seems to be rooted in cheerleaders who might be characterized as ‘frequently wrong, but never confused.’

In this absence of anchorage to facts and contextual truths where is one to start in an ideological fueled echolalia of lies, misrepresentations, partial truths architected by armies of K-street funded special interests and their partner PR machines? Unfortunately for the rest of us K-street and the balance of the often morally bankrupt (chase the buck) beltway bandits find gold in them their hills of fueling ‘conflict’ as a contractual or ‘annuity solution’ to their recurrent ‘bill-ability’ concerns.

Let’s be clear. If the ACA were repealed do you think any of the macro trends would slow or reverse? Would Accountable Care be set aside for an ‘unaccountable care’ status quo? How about the movement into value based or performance based payment? Might this be moved to the quicksand of failed ideas while the return to fee for services ‘happy days’ plays on and on? Will selective movement into direct or retainer based medicine somehow disappear as well (note the return to direct practice is merely the reinvention of the HMO only in more micro practice terms)? Or will care management and coordinated care be seen as merely a passing fad with an immediate return to silo based episodic care and unit revenue or pricing maximization? I don’t think so…

None of these granular market tectonics would reverse if the Act were to be defunded, repealed or somehow re-litigated in the court of public opinion or elsewhere.

So let’s place the change or transformational energy impulse where it can best serve us. Since we’ve just recognized the 50th anniversary of the tragic JFK assassination I’m reminded of this bit of timeless wisdom:

‘if you’re NOT part of the solution, you are [part  of] the problem.’

Have you looked in the mirror lately?

From FutureMed to ACO Congress and Health Insurance Exchange West Summits

By Gregg A. Masters, MPH

Today I drove north some 150 miles or so from San Diego to the Century City Plaza Hotel complex in Los Angeles on the suitably named ‘avenue of the stars’ adjacent to the Fox entertainment empire. The Sunday session at FutureMed hosted at the Hotel Del Coronado was infectious and upbeat with as usual forward thinking and doing entrepreneurs, scientists and the people who love, follow or aspire to be one of them. BYQPw7vCUAAVaWr.jpg-large

The day was packed with inspirational speakers and concluded with a keynote than none other than San Diego’s digital health superstar and agitator for the creative destruction of medicine – Eric Topol, MD.

For a tweetchat dashboard of the action at FutureMed – the event runs through this Wednesday – click here. For the program agenda and schedule click here, while the transcript to date can be accessed here and the digital dashboard chronicling reach of the footprint is here.

Meanwhile here we are at the current sessions of the 4th National ACO Congress and the 1st ‘Health Insurance Exchange Summit West’ which will no doubt be a annual affair for the near term – given the disastrous rollout of HealthCare.gov and the contrasted ‘successful’ reviews of those state administered exchanges in California aka Covered California and Kentucky aka Kynect.

As I sat in the audience at FutureMed hearing the passion of the presentors I regularly kept asking myself, ok this is all awesome stuff – from 3D printing/manufacturing of just about everything from organs to guitars, but how does it assimilate and disrupt our house of cards if not ‘calcified hairball’ (per Esther Dyson) of a healthcare financing and delivery system? And coincident as it turns out, the session I am attending for the next two days represent the best and brightest – if you will, of the aggregators if not orchestrators of the sustainable healthcare ecosystem envisioned by the triple aim?

We shall see! I will be monitoring both event hashtags via #ACOcongress and #FutureMed - and so can you.

ACOs ‘In the News’

Gregg A. Masters, MPH

heritage masthead

As the drip, drip, drip of the reported collateral fallout – both perceived and actual – of the stalemated resolution of the Federal shutdown makes it way into the American psyche we’re also seeing reports from the front on the success, indifference or failure of the ‘ACO vision’ to successfully pivot the healthcare borg from a fee-for-services (volume) to a fee-for-value paradigm.

Today’s news reports on two entities with which I am somewhat familiar – Texas Health Resources (THR) and Heritage Medical Systems (Heritage Provider Network) both parents respectively of first generation CMMI Pioneer plays. I served as the Vice President for Managed Care and Network Development at THR’s branded affiliate ‘Wellspan Health Network” (including System Health Providers (SHP) and consulting roles to Genesis Physicians Group) pre and post merger of Presbyterian Healthcare Resources and Harris Methodist Health System into THR, while at Heritage Southwest Medical Group, I championed provider network development and management including capitating specialty services for a global risk contracts.

Sourced from: ‘Digging Deeper: Lessons from an ACO Success Story.‘ Texas Health Resources

Perhaps framing the irony surrounding the confused narrative associated with the signature accomplishment of this President against a history of persistent previous legislative failure, the author notes:

We all know that the word “Obamacare” elicits immediate emotion from a good chunk of the American public. Thanks to late night TV host Jimmy Kimmel, and a media poll or two, we know that the words Affordable Care Act (ACA) do not elicit the same kind of emotion.

This only makes sense if you can buy with a straight face the sensibilities of the Tea Party cheerleading line of ‘keep your stinkin’ Government hands off my Medicare’ rant.

Meanwhile, the decisions of these two entities shed light on the underlying motivations likely to be driving in one case the decision to ‘step down’ in the risk ladder (THR) while in the second expressing a warp speed determination to proactively manage the risk exposure and deliver on the triple aim.

The author cites THR’s CIO Ed Marx aka @marxists on twitter as follows:

[THR] ….wanted to avoid paying a penalty, but was still focusing on ACO efforts. 

Whereas, Jonathan Gluck senior executive and counsel at the Heritage Provider Network notes, we’re:

…all in on the program.

This differential approach to risk is illustrative. Both entities at least in the Texas market have erratic performance. Heritage Southwest Medical Group ultimately declared bankruptcy during the global risk days in the late 90s, while THR returned to it’s hospital roots when the succession leadership vetting was over and the insurance culture of the then CEO of Harris Methodist Health System demurred to the predominant hospital culture of the Presbyterian leadership (aka the Smith v Hawthorne succession dance) by selling the Harris Methodist Health Plan to PacifiCare Health Systems.

It should come as no surprise that a physician organization untethered in any material ‘bricks and sticks’ sense to hospital infrastructure other than a drawer full of partial (at best) risk contracts should embrace the Pioneer model; whereas a hospital system even in partnership with a risk savvy physician organization the likes of ‘NTSP’ aka North Texas Specialty Physicians (_NTSP_), the JV partner in the Pioneer ACO) would step down and recalibrate their pathway options into this value shift.

The jury is out whether institutionally led health systems can re-engineer their culture let alone their asset portfolio to meet the vision quest of the triple aim via ACO intermediaries. If I were a betting man, my money would be on Dick Merkin and Mark Wagar, et al to tame the unrestrained appetite of the often maldistributed, excess capacity and misaligned production based assets.

AHIP Back in the ‘huddle’ and Reminiscent of the ‘GHAA Revolution’?

By Gregg A Masters, MPH

It’s been a very long time since I participated in an AHIP event. In fact for the record I have NEVER been to an AHIP event – that is before this week in DC. I attended, filmed, tweeted, broadcasted from, and now blog about AHIP’s ‘Medicare, Medicaid and Dual Eligible 2013 Program series.AHIP Medicare, Medicaid, Duals DC 2013

As someone who’s guided, counseled and implemented (at times successfully and other times not) some rather large proprietary, non-profit (ah hem, I mean ‘tax exempt’) health systems and their national or regionally branded provider sponsored ‘managed’ (ah hem, I mean ‘discounted’) health plans dating back to the 80s and into the millennium this is awkward if not curious (‘N’ of one?) state of affairs.

AHIP is after all is the ‘go to’ resource for the health plan community and their aligned provider and health system partners.  Yet somehow in my non traditional yet ‘mangled’ healthcare career path I managed somehow to stay outside of that tribe of dedicated and passionate healthcare professionals.

Back then, half of AHIP’s predecessor iteration was known as GHAA – the ‘group health association of America.’ This was an multi-dimensional trade label, as ‘group’ could be seen from an employer’s wholesale purchasing of group health insurance (vs. the ‘individual market)’ perspective but also from the point of it’s constituent member health plans mostly built upon ‘risk savvy’ medical group practice infrastructure – Friendly Hills, Mullikin, Bristol Park, Harriman Jones et al, at least in Southern California – though peer equivalents peppered the national lanscape, ie, Dean, Kelsey Seybold, Scott & White, InterMountain, Park Nicollet, Virgina Mason.

It’s been a while since the vertical integration and rabid consumption of group, IPA, or network model HMOs by national nameplates storming into the managed competition market and away from their indemnity roots (Aetna/US Healthcare, Prudential/PruCare, United HealthGroup, The Equitable/Equicor), but the players back then included the likes of HealthNet, PacifiCare, TakeCare, Maxicare (RIP)’ and many other national startup wannabes ie, Partners/VHA, UniHealth/CareAmerica, HealthPlan of America, HealthCare USA, to name just a few.

Nonetheless, GHAA meetings radiated with excitement and enthusiasm as the disruption vibe of the day was to bring this HMO thing from marginal (a 2nd tier class of docs, hospitals and ‘ancillary providers’ aligned with ‘HMO medicine’) into the mainstream. HMOs other than Kaiser Permanente, Mayo Clinic and the Cleveland Clinic were seen as less than quality ie, ‘cheaper’ medicine. Yes, back then comprehensive HMO benefits where the ‘value play’ in the group health portfolio.

Fast forward to today September 25th 2013. Consider the following: the Affordable Care Act (ACA) though approved by Congress, signed into law by the President and affirmed constitutional by the Supreme Court is a hostage to the antics of the junior Senator from Texas leading a ‘defund ObamaCare’ filibuster of sorts amidst a very real threat of a Federal Government shutdown. [Editor's Note: Consider this the leading edge of wasting taxpayer dollars to pursue a political, not healthcare solution agenda].
AHIP podium signage
Whereas, in the ‘roll up your sleaves and lets get er done’ tribe, less than a mile away at the AHIP meeting a flock of dedicated healthcare professionals and aligned stakeholders from every sector of the healthcare ecosystem [perhaps absent the patients voice?] are ‘huddling’ to share best practices, enterprise models and the technical guidance that can assist the implementation of both the spirit and intent of a very complex and mostly certainly less than ideal law.

Wow what a contrast! That ‘juxtaposition of irony’ did not escape many of the faculty including no less than one warrior of a previous similar battle, the then OMB Director Alice Rivlin, now Co-chair, Bipartisan Policy Center’s Domenici-Rivlin Task Force and Interim Director of Brookings’ Engelberg Center for Health Care Reform who opined:

‘It really is a very strange time to be here in [Washington DC] the most extreme partisan politics in my memory and I’m afraid the most broken that I have seen our democratic process. Healthcare and health insurance are caught right in the middle of this dysfunctional situation……and [in view of the potential Federal Government shutdown] given this ‘disconnect’… you might wonder, have they lost their minds? And the answer is YES!’ – Alice Rivlin

So amidst this self imposed ‘faux’ crisis the title of the blog is to analogize the ‘return’ of AHIP to its original revolutionary roots. Given the scope, range and depth of the Act, making the ACA work is in the words of previous acting director of CMS and champion of ‘the triple aim’ Don Berwick an ‘all hands on deck’ affair. We need each other all rowing in the same direction if ‘we’ are to matter this time.

If not, the party for the public/private hosting of American medicine – both financing and delivery may be over.  It’s certainly debatable whether AHIP ever migrated away from their GHAA roots or not, but this is one observer’s experience in prior team huddles.

A Juxtaposition of DC Irony

By Gregg A. Masters, MPH

It’s Monday in DC and the Capitol is distinctly vibrant albeit with a peculiar though eclectic mix of create vs.  deconstruct energies.

imageSome might say this attitudinal ‘chemical cocktail’ is in part sourced from a mix of ‘doers’, but also a smidge if not even a heaping portion of the just say ‘hell no’ [to Obamacare] crowd. For reference see: the latest effort by the House to derail health reform via a defund the act showdown with the Democratic controlled Senate and the President himself.

Yet amidst this continuing dance of oppositional strategizing we’re at the Renaissance Hotel DC for a series of one might characterize as ACA ‘implementation conferences’. These are principally the health plan doers who are under a mandate to reinvent themselves, and craft a sustainable market role for their members. The AHIP cohort is perhaps most visible via Aetna, Humana, United HealthGroup as well as others, who are intent upon making the best of this complex piece of legislation known as ‘the Affordable Care Act’. This gathering of players has huddled to support each others efforts and identify and share best practices to model as the industry collectively pursues the triple aim or alternatively cast as the coveted sustainable healthcare ecosystem.

One can assume the overwhelming mission of those attending the AHIP Conference trilogy are here to learn about if not advocate for the three pillars associated with the ACA: the tweaking of Medicare from volume to value via ACOs and other innovations, the significant expansion of Medicaid and the rapid expected growth in  ‘Dual Eligible’ population.

For conference schedule click here.

The hashtag for the conference is #AHIPMCMCConf.