The @Aetna and @Humana Marriage: Will It Be Different This Time?

by Gregg A. Masters, MPH Wow! Ahead of the 4th of July weekend Mark T. Bertolini (@mtbert) and Bruce D. Broussard (@BruceDBroussard) both savvy and seasoned managed health care industry players and visionary captains at @Aetna and @Humana respectively, announced their marriage via a $35 billion, see Bloomberg story: ‘Aetna-Humana Deal to Lower Consumer Costs, …

The ACA, ACOs and Health System Reform 5 Years Later

By Gregg A. Masters, MPH In the relentless sound byte and laughable misrepresentation of facts proffered by ideologues intent upon diluting if not repealing the ACA, one consistent voice of reason and evidence mindfulness is that presented by the cogent and thoughtful reflections on the indicia of ACA implementation courtesy of ‘team Commonwealth Fund’ aka @CommonWealthFnd. …

Three Reasons Your ACO Will Likely Fail

by Gregg A. Masters, MPH I’ve seen this before, and many times at that, see: 6 Reasons Your ACO Will Fail (A Series), Any One Will Do.‘ While some continue to debate and attempt to repeal the Affordable Care Act, the underlying market dynamics on which the vision of ‘Accountable Care‘, the triple aim or …

A Fork in the Road: ACOs vs. Direct Practice?

by Gregg A. Masters, MPH In the run up to the passage of the Affordable Care Act (select milestones here), the Senate Finance Committee under the leadership of Chairman Max Baucus presided over a comical volume of amendments proffered by his colleagues on the other side of the isle, see: ‘Senate Democrats Lead Historic Passage …

Is Evolent Health the ‘New, New’ Healtheon?

By Gregg A. Masters, MPH There are parallels worth considering! But first for those who’s event horizons’ don’t reach back to the Healtheon era (mid to late 1990’s) a little history may help with the construction of this narrative. Perhaps the dots are optimally connected by the talented and best selling author Michael Lewis in his book …

An ACO Update via Leavitt Partners

By Gregg A. Masters, MPH Just released is the continuing pulse of the accountable care industry (not just ACOs per se) via the consulting firm branded with the imprimatur of a former Secretary of HHS Michael Leavitt who opines from the Red State of Utah on the progress made by market driven initiatives outlined in …

The ‘NexGen ACO’: CMS Speaks [again]

By Gregg A. Masters, MPH At one level you have perhaps the most risk savvy and successful operators in the Medicare Advantage space aka ‘CAPG‘ (the California Association of Physician Groups) closely tethered to it’s less geographically constrained though California domiciled partner IHA as in ‘Integrated Healthcare Association’ explicitly advocating for the preservation of the …

Value Based Care: what we can learn from those who succeeded (and failed) in Year 1 of the Medicare Shared Savings Program?

By Randall Williams, MD* “The definition of insanity is doing the same thing over and over again and expecting different results.” — Albert Einstein If you want to lead your organization to success with value based care, I’d like to help you avoid the mistake of committing organizational insanity. As I’ve written before, all value …

Precision Medicine v. Accountable Care: A Faux Choice?

By Gregg A. Masters, MPH Whether you call it personalized medicine or as Eric Topol MD prefer’s ‘individualized medicine’ or even via the possible conflation of the two c/o the President @BarackObama ‘Precision Medicine’s’ initiative (see fact sheet here), it strikes me that we may need an emerging business model glossary to make sure we’re …

The ACO: Seen One? You’ve Seen One…

A/C/O Accountable/Care/Organization According to the Centers for Medicare and Medicaid Services (CMS) an Accountable Care Organization (ACO) is defined as: …groups of doctors, hospitals, and other health care providers, who come together voluntarily to give coordinated high quality care to their Medicare patients. While the goal of such broadly cast and some may say overly …