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

What's Next?
So where does this leave ACOs over the next few years? The definition of an ACO will broaden to include a wide range of commercial insurance pilots based on narrow scope and provider integration. Some of these pilots will focus on improved ordering processes; others will focus on bundled payment or outlier management. New payment models will drive dramatic changes across their markets, including a focus on smart growth strategies, appropriateness, more effective management and care redesign across Systems of CARE. I suspect that many ACO lessons, coupled with other drivers, will continue to push market consolidations.

I am skeptical about whether we will be discussing ACO implementations in 5 years and I have little doubt that, at the least, the ACO (Version 3.0) of 2016 will have a very different structure than today's model. In 2016, I surmise that ACOs will be viewed as an important change agent from earlier in the decade that helped shape the evolution of hospital Systems of CARE. They will be viewed as a message that helped craft a new care delivery model rather than being the model itself, creating improved performance and more consolidated care integration, as the national health care dialogue evolved to a new level, shaped by these vectors of change.