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April 17, 2018

Overcoming Challenges to US Payment ReformCould a Place-Based Approach Help?

Author Affiliations
  • 1Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Lebanon, New Hampshire
  • 2Center for Health and Community, University of California, San Francisco
JAMA. 2018;319(15):1545-1546. doi:10.1001/jama.2018.1542

Accountable care organizations (ACOs) cover more than 32 million individuals in the United States.1 However, despite improvements in patient experience, financial savings have been limited, and the effect of ACOs on health outcomes remains unclear. Several countries, including England, Sweden, and New Zealand, have adopted “place-based” approaches to organizing health services aimed at integrating care, improving population health, and controlling costs. Place-based approaches are defined as giving health care organizations or systems some degree of responsibility for the health or care of all individuals living in a specific place: a geographically defined area such as a county, hospital referral region, or state. As the United States moves away from mandatory participation in payment reform, the current place-based reforms in England offer some useful insights for US policy makers.

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