Now that the federal health reform legislation (the Health Reform Act)1 has been enacted, efforts have turned to its implementation. Although so far the attention has been focused on the provisions relating to health insurance coverage, the most revolutionary portion of the act may turn out to be those provisions that aim to improve the quality and efficiency of health care services, particularly through payment and delivery system reform. Such reform is designed to set in motion a process that will lead to the restructuring of the organization of the health care delivery system with the aim of improving its “value,” i.e., its quality and efficiency. It entails reforming the way providers are paid to incentivize them to change the way they deliver care in a manner that improves the value of such care.
Among the most significant of the payment and delivery reforms in the Health Reform Act are those that would encourage providers to organize into new entities known as “accountable care organizations” (ACOs). ACOs are intended to serve as a vehicle through which physicians can become integrated with each other and other health care providers to improve the coordination of their care and be rewarded for improving the quality and efficiency of their care.
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