title: Fostering accountable health care: moving forward in medicare.
abstract: To succeed, health care reform must slow spending growth while improving quality. We propose a new approach to help achieve more integrated and efficient care by fostering local organizational accountability for quality and costs through performance measurement and "shared savings" payment reform. The approach is practical and feasible: it is voluntary for providers, builds on current referral patterns, requires no change in benefits or lock-in for beneficiaries, and offers the possibility of sustained provider incomes even as total costs are constrained. We simulate the potential expenditure impact and show that significant Medicare savings are possible.
authors.affiliation: Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, New Hampshire, USA. Elliott.S.Fisher@dartmouth.edu
authors.forename: Elliott S
authors.initials: ES
authors.lastname: Fisher
authors.forename: Mark B
authors.initials: MB
authors.lastname: McClellan
authors.forename: John
authors.initials: J
authors.lastname: Bertko
authors.forename: Steven M
authors.initials: SM
authors.lastname: Lieberman
authors.forename: Julie J
authors.initials: JJ
authors.lastname: Lee
authors.forename: Julie L
authors.initials: JL
authors.lastname: Lewis
authors.forename: Jonathan S
authors.initials: JS
authors.lastname: Skinner
mesh_terms: D005376:Financial Management / Q000592:standards*; D018166:Health Care Reform; D006297:Health Services Accessibility / Q000191:economics*; D006801:Humans; D006278:Medicare; D012941:Social Responsibility; D014481:United States