We've been consistently skeptical of the CMS ACO program here in this space.  There are many reasons for our raised eyebrow, but none is more powerful than the consistent pushback from the ACO table by the big, mature integrated delivery systems that are tailor made for this program.  This story in Politico details the thinking of the Henry Ford system in Detroit, a member of the mature, integrated behemoth class for sure, to not participate in the CMS ACO program.

Two things are noteworthy for us in the story.

First, Ford is doing several things, including a massive medical home build out and participating in the CMS bundled payment program.  They are also doing some interesting things with the commercial payers in their market.  Here is an interesting quote from the story: “Health plans can do things that government programs aren’t able to do. Those models that exist in the private sector today are much more flexible [than CMS programs], tailored to the needs of providers and consumers.” 

And that is the point.  CMS rolling out one program that has to be applied in many diverse markets is not a good idea.  But when local health plans and local provider networks, hospitals and aligned physicians, sit down together to design what can work in their community, some good stuff will emerge.

We continue to believe in the ACO idea, but the commercial (read: local) version of it much more than the CMS (read: federal) version.

Second, in the endless discussions we've had over the last few years about the economy, one of the themes is 'uncertainty,' specifically the role uncertainty plays in the decision making of businesses.  As you read this story, you get a firsthand view of how uncertainty played in the actions that will, and will not, be taken by the Henry Ford system.