4th National ACO Summit: Some Contextual Reflection

By Gregg A. Masters, MPH

When ‘Acting Administrator’ of CMS Don Berwick gleefully announced the final rule guiding the development and Federal certification of Accountable Care Organizations (ACOs) on October 20th, 2011, he thereby officially unleashed the power of the largest single payer for healthcare services in the United States to simultaneously govern while informing the future of healthcare transformational business models.

For the ‘red letter day’, upbeat announcement, see: Accountable Care: Reports from the Front.

Since the release of the final rule, sentiment has been somewhat of a challenge to gauge and report accurately. Unlike the HMO era, the ACO market is not a homogenous one, since you have the ‘book of business’ associated with Medicare Shared Savings Program, as well as the commercial (i.e., private market) derivative book organizing under ‘accountable care collaborations’ and even patient centered medical homes.

So while a relatively small subset of the Affordable Care Act the sections specific to ACOs represent a disproportionate yield in terms of the transformational upside of the Act to deliver on it’s promises of the ‘triple aim’ (whether planned and realized via intended as well as the ‘meta unintended consequences’ of unleashing both statutory and pilot/demonstration fueled innovation).

Thus the context, if not the metrics associated with the results reported to date, of the 4th National ACO Summit leads this observer to conclude that the ACO market sentiment has shifted from skepticism to the outright bullish determination to get in the game.

Indecision is a decision….with increasing market risk.


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