ACO’s, CMS, and ‘Tea Leaves’

Not sure what the latest count is on the comments to the ACO NPRM, see submitted comments on anti-trust enforcement, here, but amidst the range of direct commentary, and downstream banter, the following read is proferred: the stakeholder community (broadly cast) is rather, uh hum, ‘engaged’.

It’s been said, the opposite of love is not hate, but ‘indifference’. Extrapolating here, the fact that every healthcare special interest group from providers, to payers, to their channel partners and/or intermediaries, is now on record either in favor or, or opposed to specific provisions or principles the ACO rule and sequelae, ie., Pioneer Model et al add ons, there is no shortage on conversation on ACO’s. The pro-rule, pro shared governance and patient centered indicators consumer voice is reflected here.

Advantage CMS?

Having listened to, interviewed, and generally followed engaged peeps in the ACO conversation including CMS, my sense is our ‘transformationally inclined’ friends in DC are both encouraged and hopeful with the process. Rather than retrenching or feeling overwhelmed by the level discourse, or perceived need to retool their approach, my sense of their thinking is ‘isn’t it great we have so much engagement in the process?’

Since we’ve been at this ‘bend the cost curve’ and improve quality by minimizing variance and promoting evidence based medicine, via a series of acronyms too lengthy to mention, truth be told, we have collectively failed. The rapacious appetite of the healthcare borg is alive and well. The percent of GDP we consume remains on it’s unsustainable and upward trend.

ACO’s whether in principle or operational terms (yet to be finalized) are here to stay. The transformational imperative is perhaps more acute than ever in the 30 years that I have been engaged in the drama, dating back to the ‘office of alternative delivery systems’ in HCFA.

The time is now. Rather than find ways to point fingers, sit on sidelines or otherwise contribute copy to the ‘naysayer echo machine’, let’s be about the continuing business of transformation. The ‘event horizon’ is in sight, i.e., when GDP hits 20%, the private sector will be kicked out of the sandbox and Government will issue a top down remedy, no doubt anathema to our pluralistic commitment to public/private partnership solutions.


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