I got a nice note from a contact in the industry the other day.  He said he was at a conference where the speakers all seemed to say that the solutions to our problems would not come from the big players in our industry, organizations such as the government, payers, or hospital systems.  Instead, they posited, the change that matters will come from the thousands of small physician groups, working on the fringes of the system, making incremental but rapid change.

He sent the note because that theme reminded him of some of the things we are doing with our clients. 

It was good to hear because we are getting to do things with our clients that are making real, if not headline worthy, traction.

My second thought was, 'Where in the world was this conference?'  Granted, I have been on a bit of conference overload of late, hearing more about ACOs and all ideas associated with both the specific CMS model and the general concept than I could process.  It was refreshing, if nothing else, that someone somewhere was actually talking about something else for a change.  I wanted to go.

But as I considered his kind observation and whether or not he just wanted to sell me something, I did consider the underlying issue.

As is so often the case when industries undergo massive upheaval, and I think ours would qualify, there is a rush to attend all the conferences, read all the books, and now listen to all the podcasts, as we seek to glean from the 'leaders of the pack' the path we should take.

The result is always the proliferation of 'ME TOO' strategies that result in everyone following the same playbook and doing virtually the same thing.

Which is fine if that same thing will clearly solve the problem.  Good hand washing before surgery, for example.

But does anyone really believe that the out of the box ACO ideas are exactly right?  For Pete's sake, these are just interim rules at this point, but we've already had certain models pronounced as divine.

When there is a big problem with complex causes, don't we need a lot of experimentation and innovation?  Don't we need a stew of ideas being tried, reviewed, modified, killed, and then started again until some things bubble to the top, not because their organization has a reputation and got invited to bring their PowerPoint presentation to the resort, but because their plan actually worked? 

We'll keep working out here on the fringe and see what we can cook up.