What I saw was that the funding models and regulatory models both created substantial hurdles to bringing great technology/ drugs into the market. Clearing this up may reverse the anti-Moore’s law issues with productivity that was discussed in multiple talks.

There are some massive chicken/ egg implications around how you then get started.

Two solutions that we’ve seen from other industries would tend to suggest that a) a walled garden – one vertically integrated company — does it all to show the model; b) an open architecture of competitors develops to knit together pieces of the solution for/ by incumbent suppliers and disruptors at various points in the value chain.

I think the walled garden player is likely to have already figured out how to manage capitation without wanting to spending lots of money on hospitalization or cutting edge devices. I know a few players that look like this, but they aren’t the typical Academic Medical Center or Kaiser that people keep putting forward.

I especially liked this:

“A strong reinsurance market that understands the risk to these risk-taking health entities will need to be created (which then limits the risk to providers)”

Its arguable that conventional reinsurance markets are so wedded to (relatively) simple retrospective financial models that they too are ill-suited – if not actively hostile – to the ACO model. If your financial assumptions essentially take health care methods as given – as the models of conventional reinsurers do (and what reinsurer is NOT conventional?), you are going to look askance at business models that propose to do health care differently.

In other words, ACOs will practically have to succeed in spite of conventional reinsurers; it’s doubtful, short of statutory mandates, ACO innovators can look to those reinsurers for help.