By Gregg A. Masters, MPH
In the walk and perhaps some instances trot towards forming and launching an ACO you have prominent voices on both sides of the debate. The bearish camp is perhaps best represented by the likes Jeff Goldsmith in ‘Can Accountable-Care Organizations Improve Health Care While Reducing Costs?’ or Virgina Herzlinger in ‘Herzlinger Predicts ACOs, PCMHs Will Fail‘.
While the bullish camp advocates include Donald Berwick, MD in ‘Making Good on ACOs’ Promise — The Final Rule for the Medicare Shared Savings Program‘, Drs. Elliott Fisher and Mark McCllelan, see ‘Fostering Accountable Health Care: Moving Forward In Medicare‘. Now add to the bullish view and in no uncertain terms, that of Charles Saunders, MD, President of Strategic Diversification for Aetna.
I had the good fortune to chat (to listen, click on show image to the right) with Dr. Saunders today to gain additional insight into how one rather progressive and forward thinking ‘payor’ views their interest in the ACO and Patient Centered Medical Home market, while actively re-tooling its traditional health plan business model.
Healthcare consultant and author Joe Flower recently opined ‘Even Aetna CEO admits: We’re toast‘ while noting Mark T. Bertolini aka @mtbert, proffered the following sober reckoning on the demise of the traditional health insurance business model:
The system doesn’t work, it’s broke today. The end of insurance companies, the way we’ve run the business in the past, is here.
What Bertolini sees under the auspices of the Affordable Care Act and the ACO provisions specifically are minimally transitional if not replacement vehicles to the health plan business model. A reinvented Aetna (if not entire AHIP membership) will have a lot to do with technology and a range of value added roles Aetna can play in building and supporting the drivers of sustainable healthcare ecosystems. We’ve got to get beyond simplistic notions of ‘my revenues are your expenses’, and see our collective interests in a collaborative vs. competitive future.
The visionary on point to assemble, configure if not birth the moving parts of this future is Dr. Charles Saunders. We got some of his worldview today on ‘This Week in Accountable Care.’
In the words of a very smart man, from many years ago:
No one is big enough to be independent of others – Dr. William Worrall Mayo
Perhaps we’ll pay attention this time?