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Against all odds and despite repetitive attempts to undermine, repeal, delay or otherwise deconstruct whether via litigation or the political process, the Patient Protection and Affordable Care Act remains law, and the ‘devil is in the details’ scramble is on. The great divide seems to (disproportionately) line-up between the let’s roll up our sleeves and get ‘er done crowd, and the perhaps politically motivated ‘denial-ists’ hoping to successfully challenge the constitutionality of the law.

For context, let us call your attention to a timely piece of work offered by Paul Keckley and the health policy braintrust formerly at Deloitte, titled: ‘Accountable Care Organizations: A new model for sustainable innovation‘. The title abstract is reprinted below:

‘To understand how accountable care organizations (ACOs) might drive payment reform in the public and private health care sectors, this paper reviews the basic origins, definition and drivers of ACOs, and describes key features of proposed ACO initiatives, including the federal government’s proposed pilot program. In addition, using an assessment of ACO literature and Deloitte analysis, the paper profiles four structural approaches that are eligible for ACO status and puts forth seven key capabilities that are important considerations for ACO performance. Finally, this paper offers Deloitte’s perspective on the path forward and describes potential innovations that could increase ACO adoption.’

So will it be ‘deja vu’ all over again, or will it be different this time?

While the narrative unfolds, some of us continue our quest to demonstrate what works at the granular level. Two threads are active in this innovation theater, and both of them have been featured in the health reform conversation:

  • the ‘patient centered” or primary care medical home (PCMH), and
  • accountable care organization (ACO)

We believe the hope for the effective re-engineering of our costly and inequitable sick care system lies in the energetic integration of these two principles albeit at a level perhaps different from the current regulatory perspectives wherein the both concepts have been germinated to date.