Leavitt offered the development of accountable care organizations as an example. "The ACO movement is a process. It wasn't initiated by legislation. It's been spontaneously developing for a long time."
His firm, Leavitt Partners, a Salt Lake City, UT–based healthcare intelligence business, has identified 221 ACOs across the country of which more than 73% are commercially affiliated. "This is a movement that's being powered outside of government payers. Activities I have observed in the ACO movement demonstrate to me that government payers are relatively slow innovators. I have fond memories if my time at HHS, but it is just the nature of government that it has a difficult time being an effective innovator. It's very good at powering innovation once it gets behind it, but it's not a particularly robust innovator itself."
Leavitt leveled some pointed criticism at the Center for Medicare & Medicaid Services. "I think CMS can be a helpful backer of innovation but there's evidence in the way CMS is going about it that there are times when it oversteps its appropriate role in this movement." He added that "it seems unproductive for CMS to be heavily involved in dictating how groups govern themselves. It would be a better role for CMS to help create performance criteria."