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Comment & Response
October 8, 2014

Primary Care Physician–Led Health Reform—Reply

Author Affiliations
  • 1Aledade Inc, Bethesda, Maryland
  • 2Brookings Institution, Washington, DC
JAMA. 2014;312(14):1472. doi:10.1001/jama.2014.10106

In Reply Dr Talcott raises the concern that physician ACOs merely repackage the failed strategies of primary care physician as gatekeeper of the 1990s, but there are fundamental differences.

First, the incentive structure of physician ACOs is different because they benefit from simultaneous reduction in overall spending and improvement in quality and patient experience. This creates stronger motivation for them to provide enhanced, patient-centered services that can reduce costs. Payment models that reward total cost and quality achieve lower total health care cost with more intense—and redesigned—primary care services.1,2

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