An accountable care organization (ACO) is type of managed care organization in which physicians, hospitals and other providers takes responsibility for the health and wellness of a population of patients, including responsibility for high quality, appropriateness, and efficiency of the care provided.
Yesterday, CMS announced the first batch of 27 “normal” ACOs under its Medicare Shared Savings Program (MSSP). I found five things interesting about the list: 93% were unwilling to accept downside risk. In the original proposed rule for the MSSP, ACOs would have been forced to accept downside risk. Presumably, CMS thought that “skin in
A recent article in Crains Detroit Business reported the results of a national physician survey conducted by The Doctors’ Company, a large malpractice insurer. According to the survey, 10% of physicians nationally report plans to convert their practice to a “medical home” model. But, that number was 27% for Michigan. Nationally, only 14% of physicians
I have long criticized the “informatics,” “analytics” and “business intelligence” industries for over-emphasizing the value of installing analytic software or producing a pile of routine reports. As described in a previous blog post, I have found such tools to add value only in the hands of talented, trained people with the ability to tell interesting, truthful,
In politics and professional life, achieving success requires the ability to resolve conflicts. I’ve noticed that conflicts often become entrenched because the opposing parties both simplify the conflict in black and white terms. They conceptualize their own interest as moving in one direction. And, they conceptualize their opponent as wanting to move in the opposite,
Lyle Nelson from the Congressional Budget Office (CBO) has been busy. Two weeks ago, I commented on the results of Nelson’s review of 6 Medicare Care Management demonstration projects over the last decade. At the same time that report was released, Nelson also released a companion report on the 4 “Value-based Payment” CMS demonstrations over
The Centers for Medicare and Medicaid Services (CMS) announced the final list of 32 health care provider organizations that are to participate in the “Pioneer ACO” program during 2012. The Pioneer ACO program was intended to allow provider organizations that had experience and sophisticated population management and care coordination capabilities to get started under a
CMS Announces 32 Pioneer ACOs, including 3 in Michigan Read More »
During the last 20 years, we have experienced wave after wave of new frameworks for improving health care. Each had its own terminology, ardently promoted and enforced by its zealous advocates. Each had a lifecycle that began with a long incubation period, followed by a period of explosive growth in popularity and influence, rapidly leading
The Humunculus is a metaphor for Clinical Process Improvement Frameworks Read More »
Last week, Don Berwick, MD, announced his resignation as Administrator of the Centers for Medicare and Medicaid Services (CMS). Now is a good time to explain why Dr. Berwick is one of my all time health care heroes. Apparently, I talk about Dr. Berwick a lot. A few years ago, I received one of my
Catching up on some reading, I came across this article in Medical News Today, describing the results of survey research conducted by Brenda E. Sirovich, MD, MS, and colleagues from the VA Outcomes Group (White River Junction, Vermont), and the Dartmouth Institute for Health Policy and Clinical Practice. They surveyed primary care physicians and
Primary care physicians acknowledge over-utilization and blame it on the lawyers. Read More »
The Department of Health & Human Services (HHS) today released the final rule for accountable care organizations (ACO). The new rule includes a number of changes designed to make the Medicare Shared Savings Program more palatable for health care providers who had a largely negative response to the draft rule released last March. The changes include the
HHS Releases Final ACO Rule Read More »
