Most agree on the need for restructuring the US health care delivery system and increasing the capacity to provide coordinated care across the illness continuum in a patient-centered fashion. There is strong interest in developing accountable care organizations that have the capacities to (1) monitor meaningfully patient needs and outcomes, (2) use performance indicators for assessment of physicians and other professionals, and (3) implement new forms of reimbursement that result in improved quality while constraining increases in cost. A range of exemplary models are commonly used as examples including the Mayo Clinic, the Cleveland Clinic, Kaiser-Permanente, and Geisinger Health System but these examples are poorly matched to the existing distribution of medical practices and their small sizes.
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