ACOs: The regulations are out. Now what?

The HHS recently issued its proposed regulations for accountable care organizations in Medicare, and frankly it seems to us that they are deeply conflicted.

On the one hand, the regulations are strongly aligned with a market shift to value-based healthcare:

  • Primary care drives the definition of who is “accountable” in the patient attribution model, giving primary care the patient care coordination role within the ACO.
  • ACOs will have money at stake through quality-based gain sharing programs; the emphasis is squarely on changing how care is delivered.

On the other hand, the regulations are half-hearted in bringing about the change they envision. CMS and America’s best chance for affordable healthcare is to shift to a value-based approach. And the system’s best chance to make that shift a reality is for CMS to take the lead. With almost 50 percent of the nation’s healthcare buying power, CMS is the only funding source with the regulatory authority and economic clout to change the game. But authority and clout are scarcely on view in the regulations.

ACOs: The regulations are out. Now what?