The 5 Myths of the Republican Health Reform Solution

By Gregg A. Masters, MPH

Let’s start here, the healthcare industry is a $2.5 trillion behemoth unlike any other in the US economy. At roughly 20% of GDP, 1 out of every 5 dollars spent in the US works it’s way into a complex, silo-ed, discontinuous, often schizophrenic and certainly misaligned series of volume vs. value incentives driving both provider and consumer behavior.

Yet, in spite of this unique complexity and underlying ‘whack-a-mole’ change resistant DNA, i.e., hey your expense is my livelihood, there is an mind numbingly hollow drive to oversimplify the nature of the beast and series of remedies likely to tame it’s rapacious appetite and inform pathways to a value based future.

On the mantle and representing the ‘trophy property’ in this simplification and disinformation agenda if not outright denial of the nature of the challenge, is the Republican version of what’s to replace the Affordable Care Act if it can be successfully repealed in the current Congress or upon the outcome of November’s elections with an assumed reconstituted Republican majority if not chief executive.

Here is the tired and hollow plan aka ‘The 5 Myths of the Republican Health Reform Solution’ now before the Congress on the 31st time the House has taken up the matter of the Affordable Care Act:

Myth 1: Expand HSAs (aka health or medical savings accounts)

The fundamental myth (though popular in the ‘consumer directed health plan’ circles) is that so-called ’empowered consumers’ with financial ‘skin in the game’ who are no longer insulated by third party payment, are more interested in the cost and value of services they receive. As such they will be a granular, and proactive army of micro negotiators who in the aggregate will set and enforce the ‘fair valuation’ of hospital, physician and other health services pricing (good luck!).

This is an appealing though very naive assumption about the range and nature of supply and demand equation in the healthcare market. The idea that an individual can more effectively and thus successfully exert market pressure on doctors and hospitals as individuals vs. a health plan or employer who knows the market and pools members or covered lives (insureds), and thus secures more favorable (wholesale) pricing will not occur in my (or your) lifetime. This is a patently naive view.

Perhaps if we started from this exchange basis, and did not march down a path of cost plus, usual, customary and reasonable charge, et sequelae, third party payment financing paradigms this assumption might have taken hold in the soil of a truly Marcus Welby, MD alternate universe. Or in other words, absent Hill Burton, cost plus reimbursement, and the rise of proprietary hospital systems along with their tax exempt breatheren, we might not see the proliferation of our costly ‘cathedrals of medicine’ frequently separated from the people they serve by moats, silos and their virtual pyramids of paternalism.

Myth 2: Tort Reform, Medical Liability and Lawsuit Abuse

This one is a closely held view which impacts though does not drive the cost of healthcare to the degree it’s proponents would have you believe. Clearly Medicine is not a profession without risk, however to lay the cards on the table and allege the systemic cost, access and quality variability problems we face are somehow tied to the medical liability angle is another myth of exaggeration and misdirection, see: Malpractice A Tiny Percentage of Health Care Costs, and the broader policy resource Medical Liability Policy Background Brief supplied by the Kaiser Family Foundation.

Myth 3: Buying Health Insurance Across State Lines

Another flawed view to appeal to the race to the bottom of who imposes the least amount of regulatory oversight on health plans, or admitted carriers to underwrite health insurance in a particular market. Think about it, can a health insurer, or health plan with little to no scale and/or market share in a community somehow manage to extract better rates than one who does? Not likely.

The key appeal here is solely on the absence of transparent, comparable, and minimum standards of covered benefits, which drives opacity, confuses choice and merely promotes an illusion of ‘coverage’ due to the proliferation of ‘junk insurance’ aka ‘mini-meds’ or ‘limited health benefit plans’, vs. truly comprehensive coverage. Whether one is really insured depends on the definition of ‘coverage.’ Absent coherent minimum benefit thresholds, you have no basis to compare, contrast and price one plan from another.

Myth 4: Association Health Plans

The theory is great. Leverage the power of group purchasing into the individual and small group market. The net gain from such a national conversion is likely to favorably impact cost and availability of real health insurance in the wild west of sticker shock retail plans pushed to this powerless purchaser.

Yet play out the what amounts to a clearly limited upside. The ‘best case’ for association health plans is they move towards the pricing and medical inflation trends of their substantially more powerful (from a wholesale purchaser perspective) large case and group market oriented players. There is no there, there, as these players are more likely than not to stay active in the health insurance marketplace by continuing to shift risk on to their members and/or insureds.

Further the more sanguine thinkers in the bunch, aka the likes of Aetna, UnitedHealth Group, etc., realize their traditional business models are the equivalent of dinosaurs and not sustainable. To simply empower association health plans as a solution is to ignore the broader ‘collective failure’ of health insurers to actually manage the clinical risk inherent in the underwriting of the delivery system.

Myth 5: State Run High Risk Pools

This is perhaps this biggest leap of faith and head in the sand component in the non solution alternative to the Affordable Care Act. At it’s core, and high deductibles notwithstanding, is the underwriting death spiral of a privately self funded plan, where the sick and high risk nature of the pool eventually takes down the economics of the premium v. medical loss ratio. Unless a high risk health insurance pool is part of a larger framework of comprehensive community based rating, there is no future where the price points can achieve anything approaching actuarial stability let alone some measure approximating an affordability index.

For those who may not be familiar, there is just such a program in the Affordable Care Act, titled: ‘Preexisting Condition Insurance Plan.‘

So there you have it, there really is no there, there. The Affordable Care Act is a start, and there is much work to do. Why not get about the business of making this happen, instead of engaging in the base posturing we’re seeing in Washington, D.C.?

As usual I welcome your comments and thoughts.

The ACO is a Child of the ACA

By Gregg A. Masters, MPH

Only another battle has been won, (tho’ an effing big one at that), yet the war to re-engineer America’s healthcare borg remains intact and the Act is at risk to the outcome of November’s elections. In a perfect world 100% of our resources are committed to implementation of the vision, yet in a perfect world we do not dwell.

The SCOTUS decision notwithstanding the opposition has seemingly only upped the ‘repeal and replace‘ ante if nothing other than symbolically, see: ‘House Gears Up to Repeal Obamacare (Again).’

Yet on the replace front the vocal opposition has precious little to offer in terms of substance, see: ‘Republicans Plan To Replace Obamacare With Obamacare‘.

Want to test your knowledge of what’s in the Act, take the quiz below courtesy of the good folk at The Kaiser Health Foundation:

So today we start a new series to educate the grossly misinformed American public with a campaign and the associated hashtag of #ACA101, where ACA = the Affordable Care Act and 101 = a primer or ‘just the facts’ ma’am.

The intention is to convey the essence of the Affordable Care Act, ‘one tweet at a time.’ While the attention span of the average American is somewhere south of 8 seconds, we hold the possibility that a 2,471 page document set might be digestible via 140 characters at a time.

Join us, tag your tweets with #ACA101 if your intention is to educate, not confuse.

The Affordable Care Act: What’s Changed Post SCOTUS Ruling?

By Gregg A. Masters, MPH

Found over at the Healthcare Blog, a post SCOTUS Affordable Care Act conversation hosted by Eliza Corp and led by noted healthcare futurist and consultant Jeff Goldsmith. This is well worth a view and even note taking. Among Goldsmith’s many insights is the following:

A stunning lack of understanding of what’s in the law [Affordable Care Act] – Jeff Goldsmith

From fictional ‘death panels’ to the none existent ‘public option’ the the American people are completely mis-informed on the nature and value proposition of the Affordable Care Act.

ACOs: The 2012 Line-Up

By Gregg A. Masters, MPH

A Profile of ACO’s Selected for July 1, 2012 Start Date

Per CMS Annoucement:

On July 9, 2012, the Centers for Medicare & Medicaid Services (CMS) announced the selection of 89 additional Accountable Care Organizations (ACOs) to participate in the Medicare Shared Saving Program.  The selected organizations will take responsibility for coordinating care for nearly 1.2 million beneficiaries in 40 States and Washington, D.C. In total, there now are 154 organizations participating in Medicare shared savings initiatives, serving over 2.4 million Medicare patients across the country.

All ACOs that succeed in reducing the rate of growth in the cost of care while providing high quality care may share in the savings to Medicare.  To ensure high quality of care, ACOs will report performance on 33 measures relating to care coordination and patient safety, use of appropriate preventive health services, improved care for at-risk populations, and patient and caregiver experience of care.

Five of the ACOs announced today applied for a version of the program that allows them to earn a higher share of any savings by also being held accountable for a share of any losses if the costs of care for the beneficiaries assigned to them increase.

Participation in an ACO is purely voluntary for providers.  Because the Shared Savings Program is part of the original Medicare fee-for-service program, beneficiaries served by these ACOs will continue to have free choice about the care they receive and from whom they seek care, without regard to whether a particular provider or supplier is participating in an ACO.

[More.]

CMS Names 89 New Medicare Shared Savings Accountable Care Organizations

Arizona Health Advantage, Inc, located in Chandler, Arizona, is comprised of networks of individual ACO practices, with 73 physicians. It will serve Medicare beneficiaries in Arizona.

John C. Lincoln Accountable Care Organization, LLC, located in Phoenix, Arizona, is comprised of partnerships between hospitals and ACO professionals, and hospitals employing ACO professionals. It will serve Medicare beneficiaries in Arizona.

Fort Smith Physicians Alliance ACO, LLC, located in Fort Smith, Arkansas is comprised of networks of individual ACO practices, with 78 physicians. It will serve Medicare beneficiaries in Arkansas and Oklahoma.

ApolloMed Accountable Care Organization Inc., located in Glendale, California, is comprised of networks of individual ACO practices, with 130 physicians. It will serve Medicare beneficiaries in California.

Golden Life Healthcare LLC, located in Sacramento, California, is comprised of networks of individual ACO practices and partnerships between hospitals and ACO professionals, with 57 physicians. It will serve Medicare beneficiaries in California.

John Muir Physician Network, located in Walnut Creek, California, is comprised of ACO group practices and networks of individual ACO practices, with 197 physicians. It will serve Medicare beneficiaries in California.

Meridian Holdings, Inc., located in Hawthorne, California, is comprised of ACO group practices and networks of individual ACO practices, with 60 physicians. It will serve Medicare beneficiaries in California, District of Columbia, Florida, Georgia, Maryland, North Carolina, South Carolina, and Texas.

North Coast Medical ACO, Inc., located in Oceanside, California, is comprised of ACO group practices, hospitals employing ACO professionals, and a federally qualified health center, with 281 physicians. It will serve Medicare beneficiaries in California.

Torrance Memorial Integrated Physicians, LLC, located in Torrance, California, is comprised of partnerships between a hospital and ACO professionals, with 398 physicians. It will serve Medicare beneficiaries in California.

MPS ACO Physicians, LLC, located in Middletown, Connecticut, is comprised of networks of individual ACO practices, with 38 physicians. It will serve Medicare beneficiaries in Connecticut.

PriMed, LLC, located in Shelton, Connecticut, is comprised of ACO group practices, with 116 physicians. It will serve Medicare beneficiaries in Connecticut.

Accountable Care Coalition of Northwest Florida, LLC, located in Pensacola, Florida, is comprised of networks of individual ACO practices, with 60 physicians. It will serve Medicare beneficiaries in Alabama and Florida.

Accountable Care Partners, LLC, located in Jacksonville, Florida, is comprised of ACO group practices and networks of individual ACO practices, with 65 physicians. It will serve Medicare beneficiaries in Florida and Georgia.

Allcare Options, LLC, located in Parrish, Florida, is comprised of ACO group practices and networks of individual ACO practices, with 198 physicians. It will serve Medicare beneficiaries in Florida.

Florida Medical Clinic ACO, LLC, located in Zephyrhills, Florida, is comprised of networks of individual ACO practices, with 153 physicians. It will serve Medicare beneficiaries in Florida.

FPG Healthcare, LLC, located in Orlando, Florida, is comprised of ACO group practices, with 142 physicians. It will serve Medicare beneficiaries in Florida.

HealthNet LLC, located in Boynton Beach, Florida, is comprised of networks of individual ACO practices, with 55 physicians. It will serve Medicare beneficiaries in Florida.

Integrated Care Alliance, LLC, located in Gainesville, Florida, is comprised of networks of individual ACO practices, with 115 physicians. It will serve Medicare beneficiaries in Florida.

Medical Practitioners for Affordable Care, LLC, located in Melbourne, Florida, is comprised of networks of individual ACO practices, with 126 physicians. It will serve Medicare beneficiaries in Florida.

Palm Beach Accountable Care Organization, LLC, located in West Palm Beach, Florida, is comprised of networks of individual ACO practices, with 337 physicians. It will serve Medicare beneficiaries in Florida.

Reliance Healthcare Management Solutions, LLC, located in Tampa, Florida, is comprised of networks of individual ACO practices, with 36 physicians. It will serve Medicare beneficiaries in Florida.

WellStar Health Network, LLC, located in Marietta, Georgia, is comprised of partnerships between hospitals and ACO professionals, with 1,203 physicians. It will serve Medicare beneficiaries in Georgia.

Advocate Health Partners, located in Rolling Meadows, Illinois, is comprised of partnerships between hospitals and ACO professionals, with 2,237 physicians. It will serve Medicare beneficiaries in Illinois.

Chicago Health System ACO, LLC, located in Westmont, Illinois, is comprised of ACO group practices, networks of individual ACO practices, partnerships between hospitals and ACO professionals, hospitals employing ACO professionals, and federally qualified health centers, with 523 physicians. It will serve Medicare beneficiaries in Illinois.

Deaconess Care Integration, LLC, located in Evansville, Indiana, is comprised of ACO group practices, networks of individual ACO practices, partnerships between hospitals and ACO professionals and a hospital employing ACO professionals, and a rural health clinic, with 323 physicians. It will serve Medicare beneficiaries in Illinois, Indiana, and Kentucky.

Franciscan AHN ACO, LLC, located in Mishawaka, Indiana, is comprised of partnerships between hospitals and ACO professionals, with 245 physicians. It will serve Medicare beneficiaries in Indiana.

Indiana University Health ACO, Inc., located in Indianapolis, Indiana, is comprised of ACO group practices, networks of individual ACO practices, partnerships between hospitals and ACO professionals and hospitals employing ACO professionals, and a federally qualified health center, with 1,837 physicians. It will serve Medicare beneficiaries in Indiana.

Genesis Accountable Care Organization, LLC, located in Davenport, Iowa, is comprised of hospitals employing ACO professionals, with 312 physicians. It will serve Medicare beneficiaries in Illinois and Iowa.

Iowa Health Accountable Care, L.C., located in Des Moines, Iowa, is comprised of ACO group practices, networks of individual ACO practices, a combination of hospitals employing ACO professionals, a federally qualified health center and a rural health clinic, with 1,551 physicians. It will serve Medicare beneficiaries in Illinois, Iowa, and Missouri.

One Care LLC, located in Des Moines, Iowa, is comprised of partnerships between hospitals and ACO professionals, with 402 physicians. It will serve Medicare beneficiaries in Iowa.

University of Iowa Affiliated Health Providers, LC, located in Iowa City, Iowa, is comprised of partnerships between hospitals and ACO professionals, with 1,791 physicians. It will serve Medicare beneficiaries in Iowa.

Owensboro ACO, located in Owensboro, Kentucky, is comprised of networks of individual ACO practices, with 26 physicians. It will serve Medicare beneficiaries in Indiana and Kentucky.

Quality Independent Physicians, located in Louisville, Kentucky, is comprised of ACO group practices, with 74 physicians. It will serve Medicare beneficiaries in Indiana and Kentucky.

Southern Kentucky Health Care Alliance, located in Smiths Grove, Kentucky, is comprised of networks of individual ACO practices, with 35 physicians. It will serve Medicare beneficiaries in Kentucky.

TP-ACO LLC located in Baton Rouge, Louisiana, is comprised of networks of individual ACO practices, with 50 physicians. It will serve Medicare beneficiaries in Florida, Louisiana and Tennessee.

Central Maine ACO, located in Lewiston, Maine, is comprised of ACO group practices, networks of individual ACO practices and partnerships between hospitals and ACO professionals, including a combination of hospitals employing ACO professionals. It includes 566 physicians. It will serve Medicare beneficiaries in Maine.

Maine Community Accountable Care Organization, LLC, located in Augusta, Maine, is a federally qualified health center with 125 physicians. It will serve Medicare beneficiaries in Maine.

MaineHealth Accountable Care Organization, located in Portland, Maine, is comprised of networks of individual ACO practices, partnerships between hospitals and ACO professionals and hospitals employing ACO professionals, with 1,595 physicians. It will serve Medicare beneficiaries in Maine.

Accountable Care Coalition of Maryland, LLC, located in Hollywood, Maryland, is comprised of ACO group practices, with 109 physicians. It will serve Medicare beneficiaries in Maryland.

Greater Baltimore Health Alliance Physicians, LLC, located in Baltimore, Maryland, is comprised of partnerships between a hospital and ACO professionals and a hospital employing ACO professionals, with 399 physicians. It will serve Medicare beneficiaries in Maryland and Pennsylvania.

Maryland Accountable Care Organization of Eastern Shore LLC, located in National Harbor, Maryland, is comprised of ACO group practices, networks of individual ACO practices, with 15 physicians. It will serve Medicare beneficiaries in Maryland.

Maryland Accountable Care Organization of Western MD LLC, located in National Harbor, Maryland, is comprised of ACO group practices and networks of individual ACO practices, with 23 physicians. It will serve Medicare beneficiaries in Maryland, Pennsylvania, and West Virginia.

Circle Health Alliance, LLC, located in Lowell, Massachusetts, is comprised of partnerships between hospitals and ACO professionals, with 353 physicians. It will serve Medicare beneficiaries in Massachusetts and New Hampshire.

Harbor Medical Associates, PC, located in South Weymouth, Massachusetts, is comprised of ACO group practices, with 116 physicians. It will serve Medicare beneficiaries in Massachusetts.

Accountable Healthcare Alliance, PC, located in East Lansing, Michigan, is comprised of networks of individual ACO practices, with 29 physicians. It will serve Medicare beneficiaries in Michigan.

Oakwood Accountable Care Organization, LLC, located in Dearborn, Michigan, is comprised of partnerships between hospitals and ACO professionals, with 1,546 physicians. It will serve Medicare beneficiaries in Michigan.

Southeast Michigan Accountable Care, Inc., located in Dearborn, Michigan, is comprised of ACO group practices and networks of individual ACO practices, with 333 physicians. It will serve Medicare beneficiaries in Michigan.

Essential Health, located in Duluth, Minnesota, is comprised of a combination of ACO group practices, critical access hospitals, and a rural health clinic, with 1,404 physicians. It will serve Medicare beneficiaries in Minnesota, North Dakota, and Wisconsin.

Medical Mall Services of Mississippi, located in Jackson, Mississippi, is comprised of networks of individual ACO practices and a federally qualified health center, with 487 physicians. It will serve Medicare beneficiaries in Mississippi.

BJC HealthCare ACO, LLC, located in St. Louis, Missouri, is comprised of a combination of hospitals employing ACO professionals, and rural health clinics, with 556 physicians. It will serve Medicare beneficiaries in Illinois and Missouri.

Heartland Regional Medical Center, located in St. Joseph, Missouri, is comprised of a hospital employing ACO professionals, with 199 physicians. It will serve Medicare beneficiaries in Kansas and Missouri.

Nevada Primary Care Network ACO, LLC, located in Las Vegas, Nevada, is comprised of ACO group practices and networks of individual ACO practices, with 89 physicians. It will serve Medicare beneficiaries in Nevada.

Concord Elliot ACO LLC, located in Manchester, New Hampshire, is comprised of partnerships between hospitals and ACO professionals, with 234 physicians. It will serve Medicare beneficiaries in New Hampshire.

Barnabas Health ACO-North, LLC, located in West Orange, New Jersey, is comprised of partnerships between hospitals and ACO professionals, hospitals employing ACO professionals, with 435 physicians. It will serve Medicare beneficiaries in New Jersey.

Accountable Care Coalition of Syracuse, LLC, located in Syracuse, New York, is comprised of ACO group practices, with 105 physicians. It will serve Medicare beneficiaries in New York.

Asian American Accountable Care Organization, located in New York City, is comprised of networks of individual ACO practices, with 239 physicians. It will serve Medicare beneficiaries in New York.

Balance Accountable Care Network, located in New York City, is comprised of hospitals and networks of individual ACO practices, with 1,069 physicians. It will serve Medicare beneficiaries in New York.

Beacon Health Partners, LLP, located in Manhasset, New York, is comprised of networks of individual ACO practices, with 261 physicians. It will serve Medicare beneficiaries in New York.

Chautauqua Region Associated Medical Partners, LLC, located in Jamestown, New York, is comprised of partnerships between hospitals and ACO professionals, with 200 physicians. It will serve Medicare beneficiaries in New York and Pennsylvania.

Healthcare Provider ACO, Inc., located in Garden City, New York, is comprised of networks of individual ACO practices, with 395 physicians. It will serve Medicare beneficiaries in New York.

Mount Sinai Care, LLC, located in New York City, is comprised of networks of individual ACO practices and a hospital(s) employing ACO professionals, with 2,249 physicians. It will serve Medicare beneficiaries in New York.

ProHEALTH Accountable Care Medical Group, PLLC, located in Lake Success, New York, is comprised of ACO group practices, with 281 physicians. It will serve Medicare beneficiaries in Florida and New York.

WESTMED Medical Group, PC, located in Purchase, New York, is comprised of ACO group practices, with 250 physicians. It will serve Medicare beneficiaries in Connecticut and New York.

Cornerstone Health Care, PA, located in High Point, North Carolina, is comprised of ACO group practices, with 313 physicians. It will serve Medicare beneficiaries in North Carolina.

Triad Healthcare Network, LLC, located in Greensboro, North Carolina, is comprised of networks of individual ACO practices and a hospital employing ACO professionals, with 759 physicians. It will serve Medicare beneficiaries in North Carolina.

Mercy Health Select, LLC, located in Cincinnati, Ohio, is comprised of hospitals employing ACO professionals, with 365 physicians. It will serve Medicare beneficiaries in Indiana and Ohio.

ProMedica Physician Group, Inc., located in Toledo, Ohio, is comprised of ACO group practices and networks of individual ACO practices, with 250 physicians. It will serve Medicare beneficiaries in Michigan and Ohio.

Summa Accountable Care Organization, located in Akron, Ohio, is comprised of partnerships between hospitals and ACO professionals, with 612 physicians. It will serve Medicare beneficiaries in Ohio.

University Hospitals Coordinated Care, located in Shaker Heights, Ohio, is comprised of partnerships between hospitals and ACO professionals, with 1,770 physicians. It will serve Medicare beneficiaries in Ohio.

North Bend Medical Center, Inc., located in Coos Bay, Oregon, is comprised of ACO group practices, with 112 physicians. It will serve Medicare beneficiaries in Oregon.

Coastal Medical, Inc., located in Providence, Rhode Island, is comprised of ACO group practices, with 100 physicians. It will serve Medicare beneficiaries in Massachusetts and Rhode Island.

Accountable Care Coalition of The Tri-Counties, LLC, located in Charleston, South Carolina, is comprised of networks of individual ACO practices, with 108 physicians. It will serve Medicare beneficiaries in South Carolina.

AnewCare LLC, located in Johnson City, Tennessee, is comprised of partnerships between hospitals and ACO professionals, with 673 physicians. It will serve Medicare beneficiaries in Tennessee and Virginia.

Cumberland Center for Healthcare Innovation, LLC, located in Nashville, Tennessee, is comprised of networks of individual ACO practices, with 33 physicians. It will serve Medicare beneficiaries in Tennessee.

MissionPoint Health Partners, located in Nashville, Tennessee, is comprised of hospitals employing ACO professionals, with 544 physicians. It will serve Medicare beneficiaries in Tennessee.

St. Thomas Medical Group PLLC, located in Nashville, Tennessee, is comprised of ACO group practices, with 41 physicians. It will serve Medicare beneficiaries in Tennessee.

Summit Health Solutions, located in Knoxville, Tennessee, is comprised of hospitals and ACO group practices, with 474 physicians. It will serve Medicare beneficiaries in Tennesse.

BHS Accountable Care, LLC, located in San Antonio, Texas, is comprised of ACO group practices, networks of individual ACO practices, partnerships between a hospital and ACO professionals and a hospital employing ACO professionals, with 348 physicians. It will serve Medicare beneficiaries in Texas.

Memorial Hermann Accountable Care Organization, located in Houston, Texas, is comprised of networks of individual ACO practices and partnerships between hospitals and ACO professionals, with 332 physicians. It will serve Medicare beneficiaries in Texas.

Methodist Patient Centered ACO, located in Dallas, Texas, is comprised of ACO group practices, networks of individual ACO practices and partnerships between hospitals and ACO professionals, with 269 physicians. It will serve Medicare beneficiaries in Texas.

Essential Care Partners, LLC, located in Austin, Texas, is a federally qualified health center with 275 physicians. It will serve Medicare beneficiaries in Texas.

Physicians ACO, LLC, located in Houston, Texas, is comprised of networks of individual ACO practices, with 75 physicians. It will serve Medicare beneficiaries in Texas.

Texoma ACO, LLC, located in Wichita Falls, Texas is comprised of ACO group practices and networks of individual ACO practices, with 52 physicians. It will serve Medicare beneficiaries in Texas.

Central Utah Clinic, P.C., located in Provo, Utah, is comprised of ACO group practices, with 173 physicians. It will serve Medicare beneficiaries in Utah.

Accountable Care Coalition of Green Mountains, LLC, located in South Burlington, Vermont, is comprised of ACO group practices and networks of individual ACO practices, with 42 physicians. It will serve Medicare beneficiaries in Vermont.

Polyclinic Management Services Company, located in Seattle, Washington, is comprised of ACO group practices, with 296 physicians. It will serve Medicare beneficiaries in Washington.

Aurora Accountable Care Organization LLC, located in Milwaukee, Wisconsin, is comprised of ACO group practices, with 275 physicians. It will serve Medicare beneficiaries in Wisconsin.

Dean Clinic and St. Mary’s Hospital Accountable Care Organization, LLC, located in Madison, Wisconsin, is comprised of ACO group practices and a partnership between a hospital and ACO professionals, with 701 physicians. It will serve Medicare beneficiaries in Wisconsin.

ProHealth Solutions, LLC, located in Waukesha, Wisconsin, is comprised of partnerships between hospitals and ACO professionals, with 697 physicians. It will serve Medicare beneficiaries in Wisconsin.

On the ‘Epidemiology of Unicorns’ aka ACOs

By Gregg A. Masters, MPH

We all love infographics, right? Well, courtesy of the good folks at The Advisory Board, aka @TheAdvisoryBd check out the updated map and associated legend to track with the incidence of certain ACO model types as they inevitably pepper the US landscape.

For complete blog post, click here.

An ACO Progress Report c/o CMS

By Gregg A. Masters, MPH

Can you feel it? Amidst the continued uncertainty spawned by the very principals who most directly hope to benefit from the continued diversion if not outright ‘anti ACA’ (i.e., Affordable Care Act) propaganda are data suggesting a possible shift in not only attitude but commitment to ‘accountable care’ and the structured entities codified in Federal regulation aka ‘ACOs’, to enable the transformation.

I am reminded of the Ghandi attributed and often quoted glidepath to innovation (if not revolution):

First they ignore you, then they ridicule you, then they fight you, then you win.”
— Mahatma Gandhi

One could make the argument that beginning with the Notice of Proposed Rule Making (NPRM) and the 1,300 plus comments it generated to the final rule release including the Pioneer, et al program sequelae, that we’re witnessing indicia of a paradigm shift towards a nascent ACO movement.

At the Wireless Life-Sciences Alliance meeting in May, one of Aetna’s senior executives disclosed a ‘backlog’ of 180 requests to work with the provider community in some ACO context or configuration.

So while the hollow theater continues in Washington D.C. and inside the conservative talk machine via it’s derivative ‘mindless echolalia’, we see tangible commitment to be part of the solution to the healthcare conundrum as more and more providers ‘get ACO religion’ and move away from the hand wringing towards the ‘triple aim’, or in the words of George Bernard Shaw:

This is the true joy in life, the being used for a purpose recognized by yourself as a mighty one; the being thoroughly worn out before you are thrown on the scrap heap; the being a force of Nature instead of a feverish selfish little clod of ailments and grievances complaining that the world will not devote itself to making you happy.
― George Bernard Shaw

So today we learned courtesy of CMS, via Modern Healthcare:

CMS announces 89 new ACOs

As of July 1, 89 new Medicare accountable care organizations started to serve Medicare beneficiaries in 40 states and Washington, D.C., the CMS announced Monday.

These new programs bring the total list of ACOs to 154, which includes 32 ACOs in the Pioneer ACO model from the CMS Innovation Center that were announced last December and six physician group practice transition demonstration organizations that began in January 2011.

“The Medicare ACO program opened for business in January, and already, more than 2.4 million beneficiaries are receiving care from providers participating in these important initiatives,” acting CMS Administrator Marilyn Tavenner said in a statement (PDF).

For the complete list of ACOs see: ACOs: The 2012 Line-Up.

Healthcare Unbound: San Francisco July 19th & 20th 2012

By Gregg A. Masters, MPH

Later this month amidst the mix of keynotes, panels and breakout sessions one will find relevant content specific to ACOs, accountable care and the pursuit of the triple aim. For complete conference details click here.

Two sessions of interest, include:

The keynote address: The Future of Platforms and Healthcare Unbound (aka un-tethered or digital health) by Vince Kuraitis, JD aka @vincekuraitis

  • Are Platforms a “Nice to Have” or a “Must Have”?
  • What are Key Characteristics of HU Platforms?
  • How Can Platforms Unlock Patient Value and Competitive Advantage?
  • How Do We Prepare for the Future? What are Action Steps?

This subject was of great interest at HiMSS 2012 and a top tweet in the tweetstream for quote some time both during and post conference.

And:

Technology Innovation in and Around ACOs: A Perspective on Factors Impacting Care Coordination, Moderator: Mirena Bagur, Technology Practice Leader, ReviveHealth & Assoc. Course Director “Enabling Technology Innovation in Healthcare and the Life Sciences”

Panelists:
Louis Burns, CEO, Intel-GE Care Innovations, aka @CareInnovations
Brent Lang, President & COO, Vocera Communication

Be sure and follow the conference hashtag via #hub12

Be Afraid, Be Very Afraid

By Gregg A. Masters, MPH

Watching the ensuing theater unleashed by SCOTUS’ ruling on the Affordable Care Act, I came across some similar sound bytes from a ‘by gone era’ – or so we thought.

Since we are not likely to see these disingenuous, ‘don’t confuse me with the facts, my mind is already made up’ foes fold their tents and go home defeated, we can expect a re-grouping of the troops around a yet to be crafted all out ‘Citizens United‘ fueled offensive to pick away at and then ultimately attempt it’s repeal.

Inside this earlier media enabled public discourse we find the usual suspects [or their predecessor organizations], but then again some rather unsuspecting foes of what was then an emerging and rather compelling societal and public health concern. Perhaps best framed by an actor turned politician, forecasting the threats to freedom from a Government takeover of medicine:

The doctor begins to lose freedoms; it’s like telling a lie, and one leads to another. First you decide that the doctor can have so many patients. They are equally divided among the various doctors by the government. But then the doctors aren’t equally divided geographically, so a doctor decides he wants to practice in one town and the government has to say to him you can’t live in that town, they already have enough doctors. You have to go someplace else. And from here it is only a short step to dictating where he will go. – Ronald Reagan, 1961.

One of the traditional methods of imposing statism or socialism has been by way of medicine….If you don’t do this, one of these days you and I are going to spend our sunset years telling our children and our children’s children what it was like in American when men were free. – From Ronald Reagan’s 1961 taped anti-Medicare message, “Ronald Reagan Speaks Out Against Socialized Medicine” paid for by AMA and AMPAC.

Not unlike today, there was a rather determined campaign to inject the fear of tyranny associated with an alleged Government take over of Medicine into the hearts and minds of the American public. We see many if not all of the same ‘talking points’ in the political diatribes before our very eyes and ears.  Yet, the surprises [back then] were from several usual allies of progressive thought leadership in the organization and financing of US healthcare, including:

[The Medicare bill would] set up a health care program which served little or no necessary social purpose and which would be a direct, unwarranted and completely unfair intrusion in private enterprise. – Dr. Clifford H. Keene, Kaiser Foundation Health Plan.

For a walk down memory lane, and there are some gems from the likes of American Medical Association, and the International Association of Health Underwriters, as well as context if not a score card of the sound bytes yet to come, click here.

The Affordable Care Act in Historical Context: Lead, Follow or Get Out of the Way

By Gregg A. Masters, MPH

As I have penned over at XanateMedia in ‘The Triple Aim Sets the Agenda for Healthcare Social Media Community,’ while the aftermath of the SCOTUS ruling is predictably lining up along straight partisan lines, the net takeaway for healthcare social media peeps is to get behind the ‘triple aim’.

Yet we seem to be in an unending loop of ‘Kubler-Ross moments‘ at least inside the conservative media bubble machine and their media partners including select voices in the blog-o-sphere. For those unfamiliar with the psycho-emotional journey Elizabeth Kubler-Ross and the ‘DABDA’ acronym (aka denial, anger, bargaining, depression and acceptance) she codified the predictable stages of ‘death and dying’ which can be generalized to all forms of loss – including those of the financial, legislative and even judicial variety.

This clip places the legislative accomplishment in context and should serve as a reminder that ‘the Act’ is law, call it a ‘tax’, ‘penalty’ or whatever, the reality is it has been and remains law. Let’s get on with it. There is much to do!

Summary of SCOTUS Affordable Care Act Rulings

By Gregg A. Masters, MPH

This provided courtesy of Deloitte’s ‘Special Edition Health Care Reform Memo: June 29, 2012’ where long term healthcare industry advisor and wonk Paul Keckly opines:

The decision was a bit of a surprise: I expected the law to be upheld; I did not suspect the mandate would be upheld, nor its legal standing as a “tax” the foundational justification for the ruling.

On the questions before the court:

To read complete Deloitte letter, click here.

Meanwhile, in the Day +1 of the post SCOTUS ACA ruling, I opined somewhat on ‘This Week in Accountable Care‘ discussing my take as well as the near term plans for the radio show. Suffice it to say there is an impressive line-up of some top talent who are slated to make guest appearances on the show. From health plans to medical groups, ACOs and even the consulting domain we have some informative sessions in store for you!