JAMA Network December 11, 2017
In a time of uncertainty about the future of health care in the United States, at least 2 issues are clear. First, the current system is flawed—at times delivering both too much and too little care that is often fragmented, poorly communicated, and expensive. Second, the incentives in still-pervasive fee-for-service payment models are the basis for many of these problems. The current policy antidote, consisting of alternative payment models such as accountable care organizations (ACOs), builds on the failed managed care experiment of the 1990s, again relying on a budget for a defined population of patients but this time with checks on quality, unrestricted patient choice, and attenuated financial risk.1 Although early studies of the model show only modest success...
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