From “Unicorns to Multicorns” ACOs Morphing Below Radar

By Gregg A. Masters, MPH

This is a continuing long tail series following the content rich and strategy insight generous experiences reported by the ‘risk savvy braintrust’ at the 3rd National ACO Congress aka the ‘walking the talk of innovation’ crowd.

From sound-bytes to sensibilities?

Via UC Berkeley Professor Steven Shortell, Ph.D., MPH, Professor, School of Public Health, and Blue Cross of California Distinguished Professor Health Policy and Management, and Professor of Organizational Behavior, Haas Management of Organizations Group, we get the ‘multicorns’ observation, which is informative beyond cute:

This evolutionary market shift tracks back to the humorous ‘unicorn’ observation variably attributed to Rober Margolis, MD of Healthcare Partners, or Mark Smith, MD, of California Healthcare Foundation, depending on your source, to characterize the inflated hopes of ACOs to cure all that ails our over-engineered network of ‘sick-care’ silos.

Yet, there is meaning inside the whimsical observation.

More than Just the MSSP or the Pioneers

To many keeping a pulse on the growth and dispersion, to coin an epidemiological headline from our friends at Leavitt Partners, you are likely following the reported certified entities as announced via CMS or its innovation group at CMMI. Yet, there is much more market activity brewing beneath the surface. The engagement picture, if you will, is both wider and deeper than the official view on ACO penetration as seen through the lens of a CMS certification prism. In addition to CMS Medicare, dual eligible and Medicaid activities, major health plans (Aetna, United HealthGroup, WellPoint, are ‘queued up’ [i.e., where demand is exceeding supply] with requests to joint venture accountable care or ‘ACO collaborations’ (ranging from medical homes to straight commercial versions of both single and multi-payer ACOs).

So when one thinks about innovation, and the role of ACOs in particular as well as the  ‘Federales’ (as recently tagged by Dan Munro aka @danmunro) as an untrustworthy overlord [my words] , don’t limit your thinking to the official list published by CMS. There is considerably more, and this doesn’t even begin to address the ‘direct practice’ or ‘membership medicine’ market as potentially qualified primary care medical homes for listing on State or Federally administered health insurance exchanges. There is order in the seeming discrete chaos and inherent range of ACA initiatives. So as mentioned to my friend Dan:

go deeper and ‘trust the [market] force[s]’, [of innovation], Luke!


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