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Commercial ACOs May Find Footing Where CMS Slips

Margaret Dick Tocknell, for HealthLeaders Media, August 31, 2011

I am beginning to think that the only people who are truly excited about the eventual release of the final rules and regulation for accountable care organizations are those of us who toil away in the Fourth Estate.

Think about it. When was the last time you heard a hospital, physician or health plan executive say they are waiting for the rules and regs so they can get on with the triple aim focus:  better health for populations, better care for individuals, and lower costs for all?

I remember back in April when Don Berwick, MD, the CMS administrator, introduced the 400+-pages of proposed rules for ACOs. The complex system was roundly booed. Brand names such as the Mayo Clinic and Cleveland Clinic quickly announced that they had no intention in taking part in ACOs. Hospitals and health systems raised concerns about the anti-monopoly provisions, potential problems with data sharing, risk, and the lack of patient accountability. It really seemed like the ACO concept was DOA.

But look what has happened. It seems like almost every day there's another announcement about hospitals, health plans, or physicians creating new delivery systems that hold the promise of care coordination.

"The entire healthcare market is up in the air right now," said William Rupp, M.D. the CEO of Mayo Clinic Jacksonville in Florida. "Everyone is looking at new models of cost-effective care. We're going to see a lot of different delivery models tested and it could be years before we find the models that work."

We're not talking about the government-issue, Medicare-based ACOs touted at every turn by Kathleen Sebelius or Don Berwick. Nope. These new ACOs are centered on commercial health plan membership and they are developing their own rules for meeting quality standards, cutting costs and earning bonus payments or what the Centers for Medicare & Medicaid Services likes to call shared savings.

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1 comments on "Commercial ACOs May Find Footing Where CMS Slips"


kosos (9/1/2011 at 12:22 PM)
It's interesting to consider how things have evolved since the release of those regulations last April. I think they were a good starting point for even better ideas to develop; they got the conversation started, so to speak. John Nackel gave a nice perspective on some of his ideas for an ACO alternative here: http://ignite.optuminsight.com/our-experts/opening-the-door-to-reform/ He speaks to the idea that all stakeholders, including patients, need to be equally engaged toward population health. Patients cannot be passive participants in their health care anymore. But are physicians willing to listen?