Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2009 Mar-Apr;28(2):w219-31.
doi: 10.1377/hlthaff.28.2.w219. Epub 2009 Jan 27.

Fostering accountable health care: moving forward in medicare

Elliott S Fisher  1 , Mark B McClellan, John Bertko, Steven M Lieberman, Julie J Lee, Julie L Lewis, Jonathan S Skinner
Affiliations

Fostering accountable health care: moving forward in medicare

Elliott S Fisher et al. Health Aff (Millwood). 2009 Mar-Apr.

Abstract

To succeed, health care reform must slow spending growth while improving quality. We propose a new approach to help achieve more integrated and efficient care by fostering local organizational accountability for quality and costs through performance measurement and "shared savings" payment reform. The approach is practical and feasible: it is voluntary for providers, builds on current referral patterns, requires no change in benefits or lock-in for beneficiaries, and offers the possibility of sustained provider incomes even as total costs are constrained. We simulate the potential expenditure impact and show that significant Medicare savings are possible.

PubMed Disclaimer

References

    1. McGlynn EA, et al. The Quality of Health Care Delivered to Adults in the United States. New England Journal of Medicine. 2003;348(no. 26):2635–2645. - PubMed
    2. Kohn LT, Corrigan JM, Donaldson MS, editors. To Err Is Human: Building a Safer Health System. Washington: National Academies Press; 1999. - PubMed
    3. Bodenheimer T. Coordinating Care—A Perilous Journey through the Health Care System. Annals of Internal Medicine. 2008;358(no. 10):1064–1071. - PubMed
    1. Orszag PR, Ellis P. The Challenge of Rising Health Care Costs—A View from the Congressional Budget Office. New England Journal of Medicine. 2007;357(no. 18):1793–1795. - PubMed
    2. Schoen C, et al. How Many Are Underinsured? Trends among U.S. Adults, 2003 and 2007. Health Affairs. 2008;27(no. 4):w298–w309. doi: 10.1377/hlthaff.27.4.w298. published online 10 June 2008. - DOI - PubMed
    1. Baicker K, Chandra A. Medicare Spending, the Physician Workforce, and Beneficiaries' Quality of Care. Health Affairs. 2004;23:w184–w197. doi: 10.1377/hlthaff.w4.184. published online 7 April 2004. - DOI - PubMed
    2. Fisher ES, et al. The Implications of Regional Variations in Medicare Spending, Part 2: Health Outcomes and Satisfaction with Care. Annals of Internal Medicine. 2003;138(no. 4):288–298. - PubMed
    3. Fowler FJ, Jr, et al. Relationship between Regional per Capita Medicare Expenditures and Patient Perceptions of Quality of Care. Journal of the American Medical Association. 2008;299(no. 20):2406–2412. - PMC - PubMed
    4. Sirovich BE, et al. Regional Variations in Health Care Intensity and Physician Perceptions of Quality of Care. Annals of Internal Medicine. 2006;144(no. 9):641–649. - PubMed
    1. Congressional Budget Office. Geographic Variation in Health Care Spending. 2008
    2. Wennberg JE, Fisher ES, Skinner JS. Geography and the Debate over Medicare Reform. Health Affairs. 2002;21:w96–w114. doi: 10.1377/hlthaff.w2.96. published online 13 February 2002. - DOI - PubMed

    1. In its recent reports, the Medicare Payment Advisory Commission (MedPAC) has also focused on these questions and has made major contributions to our thinking. The term accountable care organizations emerged in a discussion between Elliott Fisher and Glenn Hackbarth, the MedPAC chair at the time.

Publication types