BACKGROUND Physicians naturally form networks. Networks could form a rational basis for Accountable Care Organizations (ACOs) for defined populations of Medicare beneficiaries. OBJECTIVES To use methods from network science to identify naturally occurring networks of physicians that might be best suited to becoming ACOs. RESEARCH DESIGN, SUBJECTS, AND MEASURES Using nationally representativ...

Health care delivery today requires a fundamentally different approach— and a new breed of physician leaders who can rally around new requirements resulting from changes in health care financing, physician reporting requirements, standards for accountable care organizations, clinical process improvements and team-based care. Today, physician leaders are being measured by the results they achiev...

Accuracy of spending-based provider performance metrics is limited by random variation and components of spending that are uncontrollable by providers. Such components vary according to the care management focus and operational maturity of each provider group. This study uses data from New Jersey Medicaid accountable care organizations (ACOs) to examine how carving out uncontrollable components...

A key issue in the decades-long struggle over US health care spending is how to distribute liability for expenses across all market participants, from insurers to providers. The rise and abandonment in the 1990s of capitation payments-lump-sum, per person payments to health care providers to provide all care for a specified individual or group-offers a stark example of how difficult it is for p...

Editorial Note: At its September, 2015 meeting in Mahnomen, Minnesota, the National Advisory Committee on Rural Health and Human Services examined the changing nature of the health care system in the United States and how rural providers can be included in these changes (known as Delivery System Reform (DSR)) without undermining access to quality health services. During the meeting the Committe...

n engl j med 359;12 www.nejm.org september 18, 2008 1202 tients would be free to leave their medical home at any time — with no explanation required — and either enroll in another one or return to the traditional fee-forservice model. The demonstration program, if successful, will be one small step along what many policymakers view as a path toward slower growth of expenditures and improved car...

The success of accountable care organizations (ACOs) under global payment may depend in part on a common yet poorly understood clinical decision: the patient referral in the outpatient setting. Fundamental to collaboration among physicians and other health care professionals, patient referrals have been largely ignored in the payment reform debate. Referral rates intheUnitedStatesmorethandouble...

a s health systems prepare for healthcare reform, they are focusing significant resources on developing accountable care organizations and medical homes and on preparing for bundled payments and population-based reimbursement. However, current economic trends combined with an analysis of the impact of key healthcare reform initiatives will require health systems to take significant cost out of ...

More than seven of 10 adults believe the U.S. health system needs fundamental change or complete rebuilding. Most adults surveyed reported difficulties accessing care, poor care coordination, and struggles with the costs and administrative hassles of health insurance. In addition, the survey finds substantial evidence of inefficient and wasteful delivery of health services. When looking toward ...

PROVIDENCE – G. ALAN KUROSE, MD, MBA, president and CEO of Coastal Medical, recently described the growth and transformation of the designated Accountable Care Organization (ACO) over recent years to the Executive Masters in Healthcare Leadership program at the Brown School of Public Health. Dr. Kurose, who began his career in a small internal medicine practice, gave a snapshot of Coastal: It i...