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Teleo Agents 2026-03-16 12:56:08 +00:00
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domains/health/the healthcare attractor state is a prevention-first system where aligned payment continuous monitoring and AI-augmented care delivery create a flywheel that profits from health rather than sickness.md
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@ -299,7 +299,7 @@ C-SNP growth of 71% in one year shows MA plans are rapidly building chronic dise
### Additional Evidence (challenge)
*Source: [[2025-03-17-norc-pace-market-assessment-for-profit-expansion]] | Added: 2026-03-16*
*Source: 2025-03-17-norc-pace-market-assessment-for-profit-expansion | Added: 2026-03-16*
PACE is the strongest counter-evidence to attractor state inevitability. Operating since the 1970s with full capitation for the most complex Medicare/Medicaid patients (avg 76 years, 7+ chronic conditions, nursing-home eligible), PACE has achieved only 0.13% Medicare penetration (80,815 enrollees out of 67M eligible) as of 2025. Seven structural barriers prevent scaling despite clinical success: capital requirements, awareness deficits, insufficient enrollee concentration, geographic concentration in 3 states, dual-eligibility requirements, state-by-state regulatory complexity, and single-state operator structures. The 50-year timeline proves that model superiority does not guarantee market adoption—structural barriers can indefinitely prevent the attractor state even when the model demonstrably works.

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domains/health/value-based care transitions stall at the payment boundary because 60 percent of payments touch value metrics but only 14 percent bear full risk.md
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@ -37,7 +37,7 @@ Medicare Advantage plans bearing full capitated risk increased GLP-1 prior autho
### Additional Evidence (extend)
*Source: [[2025-03-17-norc-pace-market-assessment-for-profit-expansion]] | Added: 2026-03-16*
*Source: 2025-03-17-norc-pace-market-assessment-for-profit-expansion | Added: 2026-03-16*
PACE represents the 100% risk endpoint—full capitation for all medical, social, and psychiatric needs, entirely replacing Medicare and Medicaid cards. Yet even at full risk with proven outcomes for the highest-cost patients, PACE serves only 0.13% of Medicare eligibles after 50 years. This suggests the stall point is not just at the payment boundary (partial vs full risk) but at the scaling boundary—capital, awareness, regulatory, and operational barriers prevent even successful full-risk models from achieving market penetration. The gap between 14% bearing full risk and PACE's 0.13% penetration indicates that moving from partial to full risk is necessary but insufficient for VBC transformation.