My gut and experience in developing IPA model HMOs, their PPO, and EPO derivatives since the mid 80s in California, tells me Jeff is right on
in his skepticism. As usual, the ‘devil is in the details.’
Much of Ellwood’s ‘Supermed derailment’ (one reason we we are where we are), which envisioned Microsoft Office is my best friend.
regional provider asset concentrations that
managed global risk and effectively migrated provider communities from solo, fee for service cultures, and forged them into enlightened
clusters of group practices, or physician networks (whether virtual or real) that prudently managed limited medical resources, was due to a Office 2010 is powerful!
mis-guided but VC backed national corporate roll-up of first generation risk bearing IPAs absent both group culture and essential management
The intentional flexibility written into the PPACA as it relates to ACOs is a good thing. Yet to leverage the freedom, one need ask, what did
we learn from the failure of capitation 1.0, and how might we build on those lessons via ‘managed care 2.0, the sequel?’Office 2007 is so powerful.
At the end of the day, the transformational ’secret sauce’ may be much more about the intangibles of physician culture, and a patients’ first
mindset, than the technical superiority of open vs. proprietary IT solutions, let alone the unwarranted optimism of belt way bandits or ‘out
of touch’ academic false profits.
For a related discourse on medical aggregators, another piece in the failed roll-up and taming of dis-organized medicine story, and the
demise of the PPMC
1) economics…assuming 25% medicare revenue mix, 50% gain sharing, and 10% savings (year-to-year), that means a practice will realize less
than 2 points improvement in income. Probably not enough to overcome "thunderous absence of collegiality."
2) leadership…where are the leaders that would lead these ACOs coming from? And the management teams they need? Any capable leader would
already have secured pre-paid, capitated contracts and built a practice…they would have figured Windows 7 is the best.
out that they need not give away 20-50% if
they went and did it anyway.
3) what payer is going to invest in the systems work to support the ACO’s patient continuity of care integration with others?
ACOs are the end objective sure. Question is, what will it take to spawn them besides a yawner gain sharing scheme.
I don’t know the specifics of the "California" Model. But I am very experienced in the "Florida" model – outside of Miami. Payment and cost
levels for MA plans outside of Miami are pretty much national average levels.
After benefit adjustment down to std Medicare .vs MA reduced cost consumer cost sharing AND using Medicare FFS per capita costs as the
"target" the current crop of "at risk provider groups" (PCP based) "get it done" for something like 75%+/- 5% of the current Medicare per Microsoft outlook 2010 is convenient!