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Leaving the Middle Ground Behind

I think the ACO programs that are based on shared savings are in an untenable position. Shared savings is a middle ground ... between "no risk" and risk ... and that middle ground is undergoing a profound disruption. For providers seeking to hedge their bets ... this is a problem. As I have stated previously FFS and Value based on FFS will have a difficult time surviving this environmental change.

This is only part 1 ... but I would suggest that the real problem is not relative costs or measurement ... but attribution and risk adjustment. Existing models and contracts are experiencing a form of force majeure - in practical terms. While we at Nascate have been rolling out robust alternatives to existing attribution approaches, a better mousetrap... the existing contracted approaches to attribution will be stressed by altering several months of utilization data due to the pandemic changes.

My simple suggestion for both payers and providers is to try and leave the middle ground behind. Move forward, adapt and embrace risk and "subscription based payment" and all that it entails. US Healthcare will never be the same and those who try to recapture the past will be bypassed by those moving forward.

-Bill Kelly

William P. Kelly is our Chief Executive Officer. He has extensive executive level experience in healthcare leadership, policy, and strategy and previously founded and served as President and Principal of Treo Solutions, LLC. As a widely recognized leader in payment policy and an expert in healthcare analytics, services, and M&A, William has published articles, edited books, and spoken nationally about the business of healthcare.