4 Accountable Care Challenges for CMS

The Accountable Care Organization model presents extraordinary opportunities.  It promises to move Medicare and potentially other payers from traditional, volume-driven, inherently inefficient, and counter-productive fee-for-service financing to a value-driven, patient-centric approach to payment and care delivery.  And unlike a multitude of other reform initiatives affecting care delivery and payment, the Medicare ACO program will be a nationwide option, not a mere demo or pilot.

Working together under the umbrella of an ACO, health systems, physicians groups, and other health care providers will be able to redesign care and realign economic incentives.  As evidenced by private sector projects led by Carol Corp and other innovators across the country, the benefits of accountable care are impressive:  higher quality of care, increased patient safety, improved patient satisfaction, strong care management and coordination, and lower costs.  In other words, a genuinely win-win scenario for patients, providers, and taxpayers.  The entry of Medicare and the prospect of significant shared savings will serve to make accountable care a viable reform across the marketplace—provided the Centers for Medicare and Medicaid Services (CMS) adopts sound policies.      

CMS plans to release proposed rules on the Medicare ACO program soon, with additional guidance also expected from the Federal Trade Commission and Office of the Inspector General.  Final rules are needed by Spring of 2011 to meet the planned January 2012 launch of the new Medicare ACO option.

Given the range of factors and considerations, drafting these policies presents CMS with a major challenge.  Fortunately, CMS is in a unique position to draw upon practical experience from successful private sector innovators, including the Carol team and pilots in the Brookings-Dartmouth ACO Collaborative.