This document discusses delivery system reform and accountable care organizations (ACOs) in the United States healthcare system. It provides context on the rationale for delivery system reform to control escalating costs. It then discusses ACOs as a model for structural and payment changes that can improve care delivery and costs. Examples of established ACOs and barriers to forming new ACOs are also summarized.

1. Delivery system reform, ACOs and physician-hospital integration The King’s Fund London March 31 2011 Francis J. Crosson, MD The Permanente Medical Group Kaiser Permanente Institute for Health Policy The post-health care reform environment in the U.S.

3. Delivery system – structural and payment change

4. Parallel tracks?

13. ACA Shared Savings Model California “Delegated Model” Full Risk Capitation Corridor Capitation FFS +/- “Bonus” FFS + “Bonus” FFS Only Bundled Payments Medicare Group Practice Demo PCMH Primary Care Specialty Care Admin. Rx (B) Referral Costs Non Referral Costs Hospital Costs Prescription Rx (D) A Schematic of ACO Risk Assumption “ Breadth” of Risk “ Depth” of Risk Permanente Medical Groups

16. Chapter 11: What needs to happen next?