CMS recently released its guidelines for four types of bundled payment pilots, a part of the Affordable Care Act.  Credited the gang at CMS - they are releasing stuff at the speed of heat.  All of those humorous and unreadable charts that we saw after the passage of the Affordable Care Act specifying all of the agencies and regulations that had to be created and rolled out are coming to pass in the regular CMS press release.

A couple of observations from this release that outlines the four models.

• If you doubt that the hospital is still the center of the healthcare universe, at least in the mind of the policy makers/bill payers, this will set you straight.  I am reminded of a conversation with a forward thinking health plan executive who lamented that physician groups were the right place to center the responsibility for improving costs and quality, but that hospital systems would grab the lead dog role because of their bulk, share of the spend, and physicians generally inability to get together and lead.
• Willie Sutton robbed banks because that is where the money was.  We got into healthcare IT for similar reasons.  This stuff requires a level of care coordination, data analytics, and several other things that can only be enabled by big IT stretched across multiple organizations.