Risk Aversion Won’t Cut it for ACOs | Part 2: The 7th Inning Stretch

In Part 1 of “Risk Aversion Won’t Cut it For ACOs,” I brought up CMS’s “Pathways to Success” proposal and the subsequent series of news articles that followed. As expected, some people are in favor of “Pathways to Success.” Others, not so much. CMS is accepting comments on their proposal from ACOs and ACO stakeholders through October of this year. As an aside, I believe CMS has overlooked one piece of human nature that is at play here. For illustrative purposes I am going to use baseball because I have often found the game eerily correlates to life in its ups, downs, and use of strategy.

Let’s say you are a coach/general manager, and you must select a few players to put on the field. You have a choice of three batters.

  • Batter A: A light hitting player with a high batting average who has a few years of experience under his belt.
  • Batter B: Has more home run power, but he also is prone to striking out.
  • Batter C: Hits even more home runs, and he also strikes out at a higher rate. To top this off, he is also very young, so he needs a lot of coaching. High risk, high reward.

The player you would select for your team is entirely based on your experience as a coach. If you’ve never previously coached a team, you want as many “Batter A’s” as you can get. He may never hit a home run, but he will do well enough to keep your team competitive. Over time, you’ll be more willing to sprinkle in a few “Batter B” types. Only those who have really mastered the game are comfortable with a stable of “Batter C” players because they know how to handle risk, and they know how to keep the high risk, high reward players focused. It requires some prior experience.

Bringing this back to healthcare, there are three problems today’s ACOs are faced with.

  1. It takes time to master running the ACO.
  2. Not everyone is truly comfortable with risk – yet (and some may never be).
  3. Medicare feels as though it’s running out of patience with those who delay taking on risk.

From CMS’s perspective, it’s sink or swim time while the ACOs appear to want more time to figure out the ever-evolving world of VBP.

Who is right? What is the right amount of experience required to truly master the ins and outs of MSSP?

The truth is that if today’s healthcare professionals are going to change the way that healthcare is practiced, they need to move forward quickly. They also need to be okay with navigating treacherous waters without a very detailed map. To succeed, leaders need to strategically invest in solutions that guide them along the path to accepting increasing levels of risk. They also need to keep close tabs on the ever-evolving rules and regulations put forth by CMS. Sometimes it’s better to play a little small ball instead of trying to compete with everyone else by hitting grand slams.

CMS’s belief that the ACO model can work is correct. It’s just a matter of getting those involved to push forward a little harder and become more aggressive. Not that there is much of a choice anymore because if CMS is the umpire, they just yelled, “PLAY BALL!”

Ryan Mackman

About the Author


Ryan Mackman, MBA, MHA - Business Consultant

Ryan Mackman has been an ACO business consultant team member with Salient since March 2018. In this role, he acts as a solution trainer, marketing and sales consultant, as well as Value Based Payment strategist. His skillset helps augment Salient’s efforts at the ACO and physician practice level. Prior to joining Salient, Mr. Mackman spent four years as the Business Administrator and Project Manager for Premier Family Health, a Level 3 Patient Centered Medical Home near West Palm Beach, FL. Mr. Mackman holds a Master’s in Business Administration and a Master’s in Health Administration from Florida Atlantic University. He received his Bachelor’s degree from the University of Florida. He currently holds a Six Sigma Green Belt Certification and is a member of the American College of Healthcare Executives.

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