Berwick hints at what proposed ACO rule might address

Any day now, CMS should come out with a proposed accountable care organization rule. Until then, we'll just have to read tea leaves. In this case, whatever hints CMS administrator, Dr. Donald Berwick lets seep out of speeches will have to suffice, if we want to glean a better sense of what CMS considered when sharpening its definition of an ACO.

One thing an ACO will not be, is "the status quo repackaged," Berwick said earlier in the week at the Engelberg Center for Health Care Reform at The Brookings Institution. The CMS head isn't supposed to comment on the new rule, which he said would be out very soon, but that didn't stop him from swiping at issues that will need "parsing" as progress is made toward integrated care.

Included in some of the areas Berwick mentioned were:

• Risk. What will risk look like? Shared savings only? Partial cap? Full cap?
• Beneficiary protections. How will beneficiaries be protected so ACOs avoid cherry picking patients?
• Measurement. What kinds of things will be measured? What's the balance between process and outcome measures? How tough should the measurements get without becoming overly exclusive?
• Privacy and data sharing. What can be shared and what not? What can ACOs know about the people in them? Is it OK with those people for them to know it?
• Generating capital. Who can invest? Maybe large hospitals can invest. What about a small practice? Is this going to go away in two years and not be worth going through the trouble of the change?

To learn more:
- read the transcript of Berwick's remarks
- check out this 200-page ACO implementation toolkit from The Dartmouth Institute/Engelberg Center
- read this story from Inside Health Reform

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