Waiting for CMS

By Gregg A. Masters, MPH

While we observe serial revisions in public release dates for the notice of proposed rules on Accountable Care Organizations (ACOs), lets play reading the “Berwick Tea Leaves’ particularly with respect to Administrator Berwick’s recent itemization of ‘the common core’ [of ACO’s] to attendees at the recent Brooking’s Event, ‘Achieving Better Care at Lower Costs through Accountable Care Organizations‘.

But first the key Berwick insight, imj, and representative of the driver of ultimate ACO success or failure:

‘..when values are strong, rules are unnecessary. When values are weak, rules are insufficient.’

If I am not mistaken, the subtext of Berwick’s message here is rather clear: ‘culture’ is key.

In other words, if the mission of the entity is not about a ‘patient centric’ or ‘patients first’ care model, whether of the contractual or ‘bricks and sticks’ integrated variety, merely smearing on a rhetorical mantra suggestive of entity alignment with the Patient Protection and Affordable Care Act (Accountable Care Organization) program goals is an unwelcome ‘business as usual’ charade (my words, not Administrator Berwicks’).

Additional notable quotes or indicia of ‘telegraphed’ ACO Value include:

An [ACO] will measure, and manage what’s important over time and space

The status quo won’t do it

We need an ‘ACO economy of innovation’

EHR’s will [need] be key

So will search, i.e., the ability to scan, and know the needs [of the population; and ‘act appropriately..]

Policy aims or touchstones to nurture include:

better care, better health at lower cost

we need create ‘doors’ (Jim Morrison reference?), or opportunities for others to compete, i.e., give us a shot (via a pluralism of sponsorship)

An ACO won’t be one thing, it will be a collection of models all of which share in common the core (above)

I so look forward to their release. I am confident Berwick ‘gets it’. The sole question that remains, is will we?