Accountable Care Organization Clinical Integration

Since its formation in 1965, Medicare has been the proverbial government manipulated “tail that wags the (private sector health care market) dog” in national health care reimbursement policy. Due to its sheer size and reach, Medicare (Parts A to D) dwarfs all other federal and state healthcare programs combined. Therefore changes affecting Medicare reimbursement and care delivery structure generally have had an immediate, profound, and transformative effect not just on Medicare, but also on private sector commercial insurance reimbursement practices as well. In this sense, Medicare has operated as a government run “incubator” for national healthcare reimbursement policies and structural market reforms. So in order to understand how healthcare has evolved to its present state, one also needs to understand how Medicare has and continues to transform the commercial healthcare industry.