Health care reform has extended insurance coverage to 32 million Americans while eliminating denial of coverage for preexisting conditions. Although this increase in financial accessibility to care is a significant achievement, it begs the question “can the health care delivery system effectively respond to the increased demand?” Given past and current experience, the prognosis is not good. Health care costs continue to increase at a rate higher than overall inflation. At the current annual rate of spending, the Medicare Trust Fund will be bankrupt in 2017. Care for the increasing number of persons with chronic illness remains highly fragmented. There are far too many preventable deaths, medical errors, hospital-acquired infections, and preventable hospital readmissions, as well as an acute shortage of primary care clinicians. The recently passed Healthcare Reform Bill (HR 3590) contains provisions to begin addressing these deficiencies, including a provision for the development of accountable care organizations (ACOs) that may be based in large part on patient-centered medical homes.
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