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Susan & Tom – if you are reading this, please know that I love you. You are terrific in-laws.  This was written in good fun. You obviously inspire me!

Did you read the magazine article or the blog post yet? You know, the one telling you about how to make the holidays less stressful. I’m sure Savannah and Matt have already featured how to avoid talking about divisive topics at the dinner table…no health care, no politics, no gun rights, no civil rights.  But we all know what happens when you run out of ways to rave about Nana’s famous green Jell-O casserole. Someone (typically, my husband who I specifically asked NOT to throw gasoline on that fire) veers away from the Jell-O to light a match… “so how about that tax bill and these health care policies?”  Boom.

My in-laws happen to be rather well versed in health care – my father-in-law sells group health insurance and my mother-in-law is a practice manager for a General Practitioner who sees many Medicare patients. They live and operationalize health care every day which means that they have strong (and valid) opinions about the Affordable Care Act (ACA) and the Centers for Medicare & Medicaid Services (CMS). I too have strong opinions about the ACA and CMS since I’ve spent many years implementing and building engagement programs for Medicare Shared Savings Program and Next Generation Accountable Care Organizations (ACOs). So as my husband opens that can of cranberries and the heated discussion begins, what do I say?

The following are my talking points that may help me live long enough to taste the blackberry cobbler (feel free to borrow any of these that apply to you):

  •  I agree, health care in this country is in trouble and isn’t sustainable at this rate. The ACA created programs like the Medicare Shared Savings Program to help improve the care of Medicare Fee-For-Service Beneficiaries and mitigate the rising health care costs.
    • “Mitigate the rising health care costs” – Nope, that doesn’t mean Nana won’t get the services she wants or needs.  It means that her overall health care experience should be seamless – her primary care physician, specialists, hospitalists, and other health care team members will all come to the table. And, she should be invited to join. They will share information about Nana so she doesn’t have to undergo testing she’s already completed.
  • ACOs are groups of health care providers such as doctors and hospitals who come together voluntarily to give high quality care to their Medicare patients.
    • Yes, voluntary participation from clinicians.
    • Yes, clinicians can be financially rewarded if their ACO lowers growth in health care costs (i.e. reduce unnecessary readmissions) while delivering quality care (i.e. meet quality standards).
    • No, it isn’t a Medicare Advantage Plan or an HMO. That means Nana can continue to visit any provider who accepts Medicare regardless of participation in an ACO, access Medicare customer service, and control who has access to her health data.   
  • Correct, although the Medicare Beneficiaries’ benefits don’t change, they should see an improvement in their care.
    • Nana should have an opportunity to complete a Medicare Annual Wellness Visit and discuss a care plan with her physician.  She may also have access to a Care Coordinator, online portal, or other health resources to help her actively participate in her health care journey.
  • Yes, the complexity of CMS initiatives and programs can cause doctors heartburn. I truly believe that CMS is working very hard to streamline and reduce burdens that many clinicians currently face (e.g. multiple quality measure requirements across various programs).  
  • Alright, my toddler is tired. I should go lay her down for a nap. Please save me a piece of cobbler and scoop of ice cream.  Retreat.

 Happy Thanksgiving!  May your holiday be filled with joy, laughter, and only minor altercations. 


Wilems Resource Group is a boutique consulting firm specializing in Compliance and Engagement solutions for the Medicare Shared Savings Program and Next Generation ACO Model. We measure success on our ability to help our clients understand program requirements, determine the appropriate level of acceptable compliance risk, and create programming that meets all regulatory requirements. We build customized compliance and engagement programs for ACOs, physicians, practice managers, and beneficiaries.  We are #raisingourlegacy.​


Maddie Short, Wilems Resource Group