"And we see a lot of failure, mostly due to the lack of the financial sustainability from the HIE model," she says. "If I'm responsible for the ACO, and I know that there needs to be a smooth flow of information to all the pieces of care, how am I going to afford to keep that going, and why should I bother now, when it may allow me a box check on meaningful use, but there's not a lot left for me to create the structure."
3. You're not an innovator
Any long-term CEO is ultimately pragmatic. And if pragmatism dictates that for whatever reason, your organization can't be an innovator, it might be best to leave others to shake out the ultimate design that will succeed as an ACO.
Though we all talk about ACOs as an acronym that actually means something concrete, only in the CMS realm have the rules finally been put in place. The rest of the market, which will include the vast majority of hospitals, is free to play around with different constructs with their commercial payers, if they desire.
Or they can choose not to play. Of course, in negotiations with payers, the normal business rules still apply. You can choose to stay out of any ACO-like contracts, but that doesn't mean your reimbursement stream is safe.
In fact, Whittington wonders whether the best solutions will come from the government ACO constructs or hospitals or physician groups.
"By limiting [CMS] ACOs to hospital and physician provider groups, I wonder if we're doing ourselves a disservice," she says. "We're not necessarily very good innovators, but we're at such a crisis point that we really need innovation. We see quite a bit of hospital leadership treating this like it's another thing they have to do."