Many people are concerned that accountable care organizations (ACOs) and other delivery system reforms in the Affordable Care Act will simply bring back the managed care days of the 1990s. These skeptics suspect that payment reforms to control high and increasing costs will simply lead to gate keeping and service denial rather than the promise of care redesign and coordination that removes unnecessary cost and delivers better outcomes.
Corresponding Author: Ezekiel J. Emanuel, MD, PhD, Office of the Provost, University of Pennsylvania, 1 College Hall, Room 122, Philadelphia, PA 19104 (firstname.lastname@example.org).
Conflict of Interest Disclosures: The author has completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Dr Emanuel reported receiving payment for speaking engagements unrelated to this work.