Obstacles and Opportunities
نویسندگان
چکیده
Management theory teaches that successful innovation requires concomitant changes among the system ’ s components to achieve congruence or fi t . 1 Similar thinking has been applied to changing the U.S. health care system. 2 In recent years, there has been growing recognition that payment reform of the U.S. health care system must be accompanied by corresponding reforms in the delivery system. Proposed payment models such as bundled payment and gainsharing require new models of physician hospital relationships to make them work. Policymakers and researchers who advocate payment reform commonly recognize the need for hospitals and physicians to link together in various organizational models, coordinate their efforts, and achieve three types of integration: economic, clinical, and cultural. Indeed, the Federal Trade Commission (FTC) and Department of Justice (DOJ) have issued guidelines that require providers to demonstrate these different types of integration if they wish to consolidate their practices and jointly negotiate with commer-cial payers. Such collaboration is not easy to achieve. For providers, the twentieth century has been characterized as a century of confl ict. 3 Much of this confl ict stems from the classic problem of trying to integrate professionals into bureaucracies. 4 Such confl ict has also been shaped by public and private sector forces specifi c to the
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