Berwick Pitches ACO Candidates

The administrator for the Centers for Medicare & Medicare Services said the agency intends to "issue an invitation to organizations that really want to create far better patient care, and who will do that by redesigning systems, investing in coordination, and becoming more patient-centered than they have ever been before. And, we want to invite organizations interested in making those changes now, not at some distant, vague time in the future. We need them now."

It's no secret that through public comments hospitals and other provider groups objected so strenuously to the risk and capital outlay requirements in the first incarnation of ACOs that CMS reengineered the program to acknowledge the preparation necessary to fully engage as an ACO.

The accelerated learning sessions are part of the CMS marketing effort to entice ACO participation. The goal of the sessions is to help potential ACO members to identify organization-specific goals to improve care delivery, improve health and reduce costs, and to develop an action plan for establishing essential ACO functions.

"We know that different organizations are at different stages in their ability to move toward an ACO model. We want to try to meet you where you are. Our hope is to offer models of participation to encourage organizations across the spectrum of readiness," said Berwick.

In his speech Berwick likened the levels of ACO -readiness to the rating difficulty for ski slopes: green circle (learners), blue square (intermediates) and black diamond (pioneer).

He described the green circle as beginners without existing systems for quality improvement or data collection, and little experience in coordinating care. He said this group wants to "get involved, but they're unsure about exactly how to move forward. Can they take the risk?"

Berwick explained that the blue square has "some of the pieces in place for being ACOs... they've made enough progress in coordinating and improving care …and they are able to take on some risk for savings and losses, but not a ton yet."

He said the pioneers are already good models of ACOs with the "people and programs already in place…to coordinate care; they already use electronic health records; they have a track record in quality improvement; and they have some type of shared governance, supporting cooperation."

Berwick touched briefly on the status of the final ACO rules and regulations saying only that "we received over 1,200 comments on the proposed rule and we are now reviewing them carefully, so that we can make the final rule better."

He said CMS doesn't know how many ACOs will exist but he is hopeful that "we will produce a final rule that, we hope, will attract many."

Still he didn't sugarcoat expectations. "Everyone that joins needs authentically to be part of the search for better, more sustainable health care in America. We are on an expedition, and, if you stand still, you won't be on it."

Berwick's speech was posted on the CMS website.

See Also:
CMS Plans ACO Learning Sessions

Proposed ACO Rules Attract Public Gripes
Leaders Respond to CMS' Proposed ACO Regulations