Accountable Care Organization Vision: Is it about ‘Principles’ or ‘Principals’?

We’ve witnessed several industry stakeholders step up and issue statements of principles pertinent to the ‘OG & E’ (i.e., the organization, governance & equity) domain for Accountable Care Organizations recently. The American Medical Association (AMA), California Medical Association (CMA), and an alliance of primary care physician organizations, including the American Academy of Pediatrics (AAFP), the America College of Physicians (ACP), and the American Osteopathic Association (AOA) have all chimed in here, here, and here, respectively.

While no doubt central to leading, and navigating the inevitable ‘white water’ of health reform implementation, what is likely to have far greater contribution to a net strategy gain for both patients and sponsoring providers, are the ‘principals’ in that conversation. Many of the leaders in key strategy slots, whether institutional or professional, are ill equipped to sort through the many issues before them; and one more time are groping for ‘check the box’ answers with deliverables’ solutions and implementation timelines. All well intended, but perhaps a case of putting the cart before the horse?

Unfortunately, since the success of the big ‘risk push-back’ in the 1990s, i.e., hospital systems, medical practice management companies and captive or independent MSOs (i.e., utility type management companies) all returning to their ‘core businesses’, there is precious little institutional memory, insight or competence in these circles at the moment.

Lets not forget to mine the ‘wisdom of the elders’ forged in the 1980’s though mid 1990’s run up to adopt the prior iteration of Berwick’s ‘triple aim holy grail’. In this blog, we will start recounting some of the more strategic mis-adventures associated with rather large, and smart, entities virtually all of them counseled by many of the same usual suspects (or there derivatives) still in that conversation today, and positioning themselves as ‘strategy experts’.

More will be revealed….


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