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So to give you a sense of why that really diminishes the incentives, if you think about an aco increasing spending during a Contract Period, medicare shared savings program, aco for example that isnt facing any Downside Risk, they are penalized for doing that. And it increases their benchmark for the following Contract Period and then they can receive a shared savings bonus for doing nothing. Under the pioneer program, they are penalized for doing more, but again theres that offsetting effect by the benchmark going up and the subsequent Contract Period, so for pioneer acos the incentives are more akin to fee for service with a lag. Then, thinking about the fixed costs of investing in systems to actually control spending, the rebasing is that much more of a problem because it may be hard for acos to recoup their investments of investing in the right systems. So that is one challenge. And i know sean and his team is working hard on a revamped proposed rule for the shared savings program.

United statesNew yorkSan franciscoDoris misnerCarolyn coughlinMichael mcwilliamsLee cvpPaul ginsburgContract periodFee serviceSean teamTeam workingOutpatient careSpecialty careSpecialty officeOffice visits