In theory, theory and practice are the same. In practice, they are not.

MACRA, Medicare, health policy

Last month Modern Healthcare published an article titled: “Many Medicare ACOs would quit rather than face risk next year.” In fact, 71% of ACOs surveyed said they would disband if forced to assume risk. Six years after the program began, we’re reminded that policy is one thing—implementation is another.

In April, SOHL hosted a panel on translating policy into practice.

Dr. Ashby Wolfe, Chief Medical Officer of CMS Region IX, gave a special presentation on MACRA and the Quality Payment Program (QPP). She showed how the Centers for Medicare and Medicaid Innovation (CMMI)’s initiatives fit together toward a unified vision. There is, in fact, a method behind the madness.

Joining her were Vanessa Schatzberg from UC San Diego Health and Jan Sebring from Family Health Centers of San Diego. Nick Macchione, Director of San Diego County HHSA, moderated the panel.

Vanessa manages UCSD’s physician ACO and clinically integrated network. She shared lessons learned from the health system’s journey—tying together policy and practice from an operational standpoint.

A nurse practitioner by background, Jan works with providers to build order sets and decision aids in the clinic’s homegrown EHR system. Jan gave the boots-on-the-ground clinical perspective. She paraphrased a quote from The Martian (2015) to characterize implementing change in healthcare: You do the math, then work the problem, then do the math… and so on.

Judging from providers’ reactions to taking downside risk, it seems that the CMS needs to do the math and work the problem some more.


Christopher K. Lee, MPH, CPHQ is Clinical Solutions Marketing Manager at Family Health Centers of San Diego. He writes for various outlets and manages a career development blog at PurposeRedeemed.com. Connect with him on LinkedIn, Twitter, or Facebook.

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