Primary Care and Accountable Care — Two Essential Elements of Delivery-System Reform

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Abstract
With discussions about U.S. health care reform focused heavily on insurance reforms, relatively little attention has been paid to the delivery-system reforms that will be required to improve the quality and coordination of health care and slow the growth of spending. The “patient-centered medical home” (PCMH) and the “accountable care organization” (ACO) are two widely discussed models for delivery-system reform that take complementary approaches to achieving these goals. The PCMH model emphasizes the creation of a strong primary care foundation for the health care system, and the ACO model emphasizes the alignment of incentives and accountability for providers across the continuum of care. With support from the Commonwealth Fund, we recently met with other leaders involved in the development of these models to clarify their key elements and identify ways of ensuring that such reforms are mutually reinforcing.

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