Many current policies and approaches to performance measurement and payment reform focus on individual providers; they risk reinforcing the fragmented care and lack of coordination experienced by patients with serious illness. In this paper we show that Medicare beneficiaries receive most of their care from relatively coherent local delivery systems comprising physicians and the hospitals where...

Interventions to improve health outcomes among patients with diabetes, especially racial or ethnic minorities, must address the multiple factors that make this disease so pernicious. We describe an intervention on the South Side of Chicago-a largely low-income, African American community-that integrates the strengths of health systems, patients, and communities to reduce disparities in diabetes...

The anticipated changes resulting from the passage of the Patient Protection and Affordable Care Act-including the proposed adoption of bundled payment systems and the promotion of accountable care organizations-have generated considerable controversy as U.S. healthcare industry observers debate whether such changes will motivate vertical integration activity. Using examples of accountable care...

Introduction T his analysis examines accountable care organizations (ACOs) and assesses their implications for antitrust policy. Consideration of the antitrust implications of ACOs is timely. Both the House and Senate health reform measures contemplate the creation of ACOs as a new class of Medicare provider while providing parallel legal authority under Medicaid. It also is possible that using...

The accountable care organization (ACO) has emerged as the centerpiece of postreform initiatives to improve the delivery of quality, cost-efficient care. As the primary partners in delivering ACOs, payers and providers have begun to collaborate on the opportunities presented by the legislation. For employers, however, this new approach to managed health care delivery models will present challen...

While family medicine has signifi cant experience with PBRNs, it has not found funding support to build the signifi cant research infrastructure required to perform large scale clinical trials that link a large number of PBRNs. Historically, large RCTs have recruited subjects divorced from the clinical care setting and community, and have been costly. The ADFM proposal to support an integrated ...