ACO Onramp or Sideline?

Listening in and tweeting about the CMS Days 1 & 2 (partial only) ‘Accelerated Learning Program’ yesterday and today, I am struck by the candor and willingness of CMS to both acknowledge & signal their intentions to work with the provider (both institutional and professional) and payor communities.

As noted today by Rick Gilfillan, MD, Acting Director, the Center for Medicare and Medicaid Innovation:

‘We can’t write the perfect [rule] model from Washington. You need tell us what works, why & how to structure it.’

I also sense a steady but open hand via the recurrent reminder, that this isn’t just about keeping provider and to a lesser degree those transaction processors (aka ‘health plans’) happy. This is first and foremost about patients: keeping them safer, healthier, and for less cost. The Medicare Trust fund outlays are not sustainable (nor are group or individual health insurance premiums for that matter, editors note). As one member of the audience commented, health care cost run rates are at $2.5 trillion currently, and expected to hit $4 trillion within 5 years….Ooops!

Apparently in the room at this first CMS Accelerated Development Learning Program session where an eclectic mix of willing and ready representatives from the ‘Pioneer Model group’, as well as the intermediates and also the ‘newbie crowd’.

My sense is this event does not rise to the level of a ‘Rick Scott-esque’ staged attempt to show off CMS flag waving supporters and make a statement to the Mayo’s and Cleveland Clinics’ of the world (including the most visible trade group representing risk savvy medical groups, i.e., AMGA, who’ve signaled their displeasure with the NPRM, and intention to not participate in the ACO program). Yet I came away with the distinct sense that CMS was issuing the following appeal: ‘either walk the talk’ (i.e., collaborate with us), or ‘get out of the way’ (again, emphasis and interpretation are solely mine).

When I met Dr. Gilfillan in DC at the Healthcare Innovation Summit earlier this month and had the privilege of interviewing him (see his keynote here), I urged him and CMS via proxy, to stand firm and not lower the bar regardless of what may have amounted to some unexpected push back by certain mission oriented ‘friends’ (AMGA, et al). By lower the bar here I do not mean ignore some of the salient feedback offered by the industry as a whole, but crater to the repeal and unwind crowd cheerleading the opposition to a CMS lead innovation conversation and rule implementation process.

May we [continue] to live in interesting times….and indeed we do!


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  1. Registration is open for the second ACO Accelerated Development Learning Session in San Fran September 15th and 16th.

    A free opportunity to learn with other organizations from well-respected and qualified faculty and meet with CMS leadership.

    There will be a third learning session in Philadelphia in Oct/Nov.

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