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Thoughts on Reform: When ACOs, Vectors, and Spin Collide

Michael Silver, PhD, Vice President, Sg2, for HealthLeaders Media, June 16, 2011

What Pilots Can Do
The archetypal accountable care model was initially developed as a physician-centric, outcome-based incentive payment model based on a high degree of provider integration, developed by academicians and policy makers to control Medicare costs. Since then, it has evolved into a diverse mix of different pilot programs. In the academic world, when one wishes to explore a model, it has become fashionable to establish a virtual collaboration to maximize the number of participants, resources, experience, outcomes data and potential solutions. That's exactly what we are seeing in the ACO world of 2010 to 2012. Early adopter provider, academic and payer organizations have banded together to accelerate the ACO learning curve. As vectors of change, these early pilots serve many valuable functions.


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Most obviously, they validate underlying assumptions vs real world experience. Second, early pilots will help to identify which of their elements need to change to improve performance in their 2014 or 2016 iterations (if they survive). Third, they keep the spotlight on the physician as an often reluctant, but critical participant in health care redesign. Finally, pilots, especially well-publicized ACO pilots, will help focus and shape national awareness and dialogue on the rapid transformation of health care payment, delivery and accountability, including patient accountability.

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