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Update from the Field

Newtown, CT - April 29, 2011 
It's fascinating to see that, despite the current body of evidence, many want to reinvent the wheel - as I read through this important  report from the Institute of Medicine I was struck by how much we know about what works.  And we can summarize it in a few words.  Incentives matter, and reengineering of care is hard but highly effective.  The examples, insights and case studies in the report would keep most health plans, employers and providers busy for quite some time. And the result would be significantly lower adjusted costs of care per capita and far better quality. It also struck me how much of this was included in the thoughtful requirements laid out by CMS for ACO wannabes.  And it also struck me how one critical ingredient is left wanting -- incentives.  The upside and upside/downside incentives included in the proposed regulations are, quite simply, a bad joke.

What this means to you - don't expect a mad rush of provider organizations to reengineer care for the paltry incentives proposed by CMS in their ACO regulations.  As one health system executive put it to me recently: "you have to have rocks in your head to accept that deal".  There are many other tools in the toolkit, however, and the IOM report has as many as you need to help you fix your part of the system.  And we are confident that the good folks at CMS will deploy new experiments that will have real incentive meat.  After all, the solutions are simple.  They simply need to be applied.
Francois de Brantes
Executive Director
Health Care Incentives Improvement Institute, Inc. 

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