CMS Leadership and Implications for ACOs

CMS Administrator Dr. Donald Berwick has been a strong proponent of Accountable Care Organizations as the ACO model embodies his triple aim of better care for individuals, better health for populations, and lower growth in expenditures.  He has committed CMS to launching ACOs under the Shared Savings program and the Center for Innovation demonstration program by the Congressional deadline of January 2012 as a hallmark of his leadership.

Dr. Berwick currently serves as the CMS Administrator under a recess appoint that expires at the end of 2011.  If he is not confirmed, which is the conventional wisdom based on Republican opposition in the Senate, ACOs will lose their strongest Administration advocate.

In March, The New York Times reported that Marilyn Tavenner, CMS Principal Deputy Administrator, was the candidate most likely to succeed Dr. Berwick.  Marilyn Tavenner’s role at CMS primarily focuses on administering the agency and managing the huge new workload created by health reform.  This role capitalizes on her management experience at Hospital Corporation of America and her experience as Secretary of the Virginia Department of Health and Human Resources under Governor Tim Kaine. She is also a nurse.

On March 28, the Congressional Quarterly (CQ) discussed her low Washington profile and noted that she has not testified before Congress or talked to the press.  With regard to ACOs, the CQ article reminded us that at a speech in March she mentioned that the Administration might delay the launch of ACOs which was quickly corrected by HHS officials and then again by Secretary Sebelius two weeks ago who said the final ACO regulations were not likely until year end.

ACOs have strong bipartisan support and strong support from Secretary Kathleen Sebelius.  Thus, any potential leadership changes in CMS should have little to no effect in the launch of the Pioneer ACO Demonstration and the Shared Savings program.