title: A Sea Change in Medicine: Current Shifts in the Delivery and Payment of Medical Care.
abstract: The Patient Protection and Affordable Care Act and the Triple Aim are driving a shift toward value-based care. Significant financial risk is being transferred from commercial insurers and government payers to hospital systems and independent physician groups. Medicare has developed bundled payment programs, but legislative barriers still impede the implementation of value-based health care.
authors.affiliation: consultant, Triangle Orthopaedic Associates, P.A.; board chair, North Carolina Specialty Hospital; executive committee member, North Carolina Orthopaedic Association; board of councilors member, American Academy of Orthopaedic Surgery; advocacy committee member, The Ortho Forum. R.B. lives in Durham, North Carolina rich.bruch@gmail.com.
authors.forename: Richard
authors.initials: R
authors.lastname: Bruch
mesh_terms: D060866:Accountable Care Organizations / Q000191:economics; D003695:Delivery of Health Care / Q000191:economics* / Q000639:trends*; D018166:Health Care Reform; D006801:Humans; D006278:Medicare / Q000191:economics; D009657:North Carolina; D064872:Patient Care Bundles / Q000191:economics; D058991:Patient Protection and Affordable Care Act; D012051:Reimbursement Mechanisms / Q000191:economics* / Q000639:trends*; D014481:United States; D062505:Value-Based Purchasing