Health care reform requires new delivery systems and new modes of payment to support them. Transitioning from a fee-for-service payment system, with its emphasis on volume, to a more value-driven payment model that encourages better health and better health care at lower cost will require realignment of financial incentives. The change will affect a diverse set of clinicians and health care organizations as they form integrated networks such as accountable care organizations (ACOs). Failure to reform payment could result in participants working in conflict with the goals of the ACO, thwarting the potential benefits of delivery reform. Primary care, the foundation of the ACO, requires payment reform to enable and make durable its transformation into a high-performance model such as the patient-centered medical home.1,2
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