Health Affairs, doi: 10.1377/hlthaff.26.1.w44 (Published online December 5, 2006) © 2006 by Project HOPE	New Online   How Would Obama, McCain Cover The Uninsured?   Cost To Cover Uninsured   Let Health IT Market Evolve   How Rate Health IT Progress?   HIV/AIDS In India, China

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Creating Accountable Care Organizations: The Extended Hospital Medical Staff

¹ Elliott Fisher is a professor of medicine and of community and family medicine at Dartmouth Medical School and the Center for the Evaluative Clinical Sciences (CECS), in Hanover, New Hampshire. He is also a senior associate in the Veterans Affairs (VA) Outcomes Group, White River Junction VA Hospital, in White River Junction, Vermont.
² Douglas Staiger is a professor of economics at Dartmouth College, an adjunct professor at the CECS, and a research associate with the National Bureau for Economic Research (NBER).
³ Julie Bynum is an assistant professor of medicine and of community and family medicine at Dartmouth Medical School.
⁴ Dan Gottlieb is a senior analyst at the CECS.

^*Corresponding author.

Abstract

Many current policies and approaches to performance measurement and payment reform focus on individual providers; they risk reinforcing the fragmented care and lack of coordination experienced by patients with serious illness. In this paper we show that Medicare beneficiaries receive most of their care from relatively coherent local delivery systems comprising physicians and the hospitals where they work or admit their patients. Efforts to create accountable care organizations at this level--the extended hospital medical staff--deserve consideration as a potential means of improving the quality and lowering the cost of care. [Health Affairs 26, no. 1 (2007): w44-w57 (published online 5 December 2006; 10.1377/hlthaff.26.1.w44)]

Key Words: Business Of Health, Consumer Issues, Hospitals, Physicians

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