The ACO rule was controversial, he acknowledged, because it required asking for tradeoffs. "You're trading off data sharing with privacy. You're trading off return to the trust fund with attractiveness to the healthcare organization financially. Because it's a gainsharing process, you have to have quality scrutiny with administrative burden. So you have these tensions.
Berwick, who had been appointed by President Obama to lead CMS in July, 2010 during a recess, left office last week after it was clear Senate Republicans would block his confirmation.
Berwick said that by the end of his tenure last week, "the amount of apparent interest [in the ACO rule] was great, but it still has to deliver. The test of whether the rule is a good rule is not just whether people say, 'oh that might work.' But whether it does work. We'll see about that."
While he was largely positive about his experience in Washington and what has been accomplished to reach his triple aim of better care, better health and lower cost through quality improvement, Berwick had less-than-kind things to say about some members of Congress for failing to understand the serious challenges the healthcare system in this country faces.
Optimism and Congress
I have two impressions, he said. "One is optimistic, and one is a little more challenging. "Look what's going on here at this meeting," he said, referring to the nearly 6,000 hospital executives, physicians and other clinicians attending the IHI forum. "You only need 20% to 30% of the industry to say now we're going to change, and I think we have that right in this forum."