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February 20, 2018

Accountable Care at the Frontlines of a Health System: Bridging Aspiration and Reality

Author Affiliations
  • 1Harvard Medical School, Boston, Massachusetts
  • 2Brigham and Women’s Hospital, Boston, Massachusetts
  • 3Massachusetts General Hospital, Boston
JAMA. 2018;319(7):655-656. doi:10.1001/jama.2017.18995

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 thus far,2 ACOs now cover more than 32 million individuals in the United States through commercial and public contracts, and the federal government has indicated it will continue to emphasize this approach.3