Launching your ACO feels a lot like launching a rocket

by Frank Tiedemann on February 26, 2012

You may find it useful to think about 3 rocketing concepts as you are planning your ACO launch. They are: trajectory, velocity, and target.

Trajectory can be thought of as the angle of ascent. In the realm of accountable care organizations is possible to describe a mental trajectory from the organizations current state to the state of patient centered medical home, from there to the state of clinically integrated network, and finally to the accountable care organization itself. As an ACO must include the legal and functional characteristics of a clinically integrated network and the primary care centered medical home, trajectory reminds us that we can start the journey with the 1st steps in the development of a primary care medical home. Incorporating the successful PCMH into the development of clinical integration helps to bring physicians along in a cooperative and supportive way. When the efforts to launch medical homes and clinical integration have physician support is far easier to begin the conversation about next steps towards an ACO.

Velocity is the speed of this journey from the current state towards accountable care. Each organization and its medical staff must decide what velocity of change they can tolerate. Of course, we understand that the federal government’s agenda surrounding health care reform is intended to measure and improve quality for Medicare recipients. There are certain deadlines built into the program that compel a sense of action or velocity. But we also understand that Congress and CMS have blinked many times in the past when deadlines have elicited unwillingness to accept mandated change. I

Indeed the first reaction to the passage of the affordable care act establishing accountable care organizations was provider rejection and lawsuits. Today, as those court cases move to the Supreme Court, there is a much greater air of inevitability to the development of accountable care organizations. For some organizations taking a wait and see attitude toward the Supreme Court review and the national election of 2012, there is still a very low velocity towards accountable care. Even so, CMS has announced the 32 Pioneer ACO organizations that will lead the movement.

Finally, we come to the rocketing concept of target. It’s always dangerous to launch without a clear oncept of where you want to arrive. The pioneer accountable care organizations have all made a commitment to the triple aims of better health, better care, and lower cost. They also committed to be the 1st mover in each of their respective service areas. Now the other organizations serving that same geography have to decide whether to follow, flank, or ignore the Pioneer ACOs.

What is your organization’s target, velocity, and trajectory towards accountable care?

I address these and other questions in my new “PlayBook for the Accountable Care Strategist”. You may download a free copy of the PlayBook at

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