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March 28, 2019

Serving Individuals and Populations Within Integrated Health Systems: A Bridge Too Far?

Author Affiliations
  • 1Alerion Institute, Alerion Advisors, North Garden, Virginia
  • 2School of Medicine, Johns Hopkins University, Baltimore, Maryland
  • 3Boston Consulting Group, Boston, Massachusetts
  • 4Arizona State University, Tempe
JAMA. 2019;321(20):1975-1976. doi:10.1001/jama.2019.2929

Growth of the integrated health system (IHS) has been rapid, encompassing 81% of acute care hospitals in 2018, 34% of large group practices, and 43% of practicing physicians who contract jointly for payment.1-3 Provisions of the Affordable Care Act (ACA) and, until recently, the preferences of private insurers called for the IHS model to become the primary organization that provides care in their communities, resulting (eventually) in increased access, lower costs, and improved quality.4 The migration to the IHS has occurred in parallel to mergers among insurers, pharmacies, benefit managers, and pharmaceutical companies and was done in response to incentives and penalties introduced by the Centers for Medicare & Medicaid Services and private insurers that were intended to transfer financial risk and ensure defined outcomes.

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