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The American Journal of Accountable Care June 2015
Communication and Accountable Care
Christopher H. Mathis, JD, MPA, Michael E. Chernew, PhD
Accountable Care Organizations: A Model for the Future
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Stay East, Young Man
Matthew Hayward, BA; and Sachin H. Jain, MD, MBA
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Lise Rybowski, MBA; Dale Shaller, MPA; Susan Edgman-Levitan, PA; and Paul D. Cleary, PhD
The Arkansas Payment Improvement Initiative: Early Perceptions of Multi-Payer Reform in a Fragmented Provider Landscape
Michael E. Chernew, PhD; William E. Golden, MD; Christopher H. Mathis, JD, MPA; A. Mark Fendrick, MD; Michael W. Motley, MPH; and Joseph W. Thompson, MD, MPH
Exploring the New Rules of Patient Engagement: AJMC's ACO and EHDC Spring 2015 Live Meeting
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Patient-Centered Teamwork in Care Transitions
Niharika Khanna, MD, MBBS, DGO; Fadia T. Shaya, PhD, MPH; Viktor V. Chirikov, MS; David Sharp, PhD; and Ben Steffen, MA
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Matthew DeCamp, MD, PhD; Jeremy Sugarman, MD, MPH, MA; Scott Adam Berkowitz, MD, MBA

Stay East, Young Man

Matthew Hayward, BA; and Sachin H. Jain, MD, MBA
What would Pioneer ACOs say to their "next-gen" counterparts? Matthew Hayward and Sachin H. Jain deliver some comic humor to accountable care.
With the Next Generation ACO program, CMS is pushing the envelope on improving care efficiency through innovative payment designs. We are excited by the announcement and have high hopes for what CMS is trying to accomplish, being confident in the program’s potential for positive transformation of care systems in the long run. Recent research by Michael McWilliams1 and David Nyweide2 show how signs of this potential are already emerging.

Simultaneously, we also acknowledge that the Pioneer program—despite these signs of promise—proved not to be the best fit for all organizations, either because these organizations weren’t ready or because of flaws in the program’s design, or both. Furthermore, we cannot help but imagine that they would probably advise other organizations to carefully self-evaluate before joining CMS’s latest program.

This cartoon is a satirization of this ambivalence in general opinion about Next Generation ACOs—we hope that readers will appreciate the humor.

Author Affiliations: Harvard Medical School (MH), Boston, MA; CareMore Health System (SHJ), Cerritos, CA.

Source of Funding: None.

Author Disclosures: The authors report no relationship or financial interest with any entity that would pose a conflict of interest with the subject matter of this article.

Authorship Information: Concept and design (MH, SHJ); drafting of the manuscript (MH); critical revision of the manuscript for important intellectual content (SHJ); administrative, technical, or logistic support (SHJ); and supervision (SHJ).

Address correspondence to: Sachin H. Jain, MD, MBA, CareMore Health System, 12900 Park Plaza Dr, Cerritos, CA 90703. E-mail:
1. McWilliams JM, Chernew ME, Landon BE, Schwartz AL. Performance Differences in year 1 of pioneer accountable care organizations [published online April 15, 2015]. N Engl J Med. doi:10.1056/NEJMsa1414929.

2. Nyweide DJ, Lee W, Cuerdon TT, et al. Association of Pioneer Accountable Care Organizations vs traditional Medicare fee for service with spending, utilization, and patient experience [published online May 4, 2015]. JAMA. doi:10.1001/jama.2015.4930.
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