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Many Large Medical Groups Will Need to Acquire New Skills and Tools to Be Ready for Payment Reform



The Issue

New approaches to paying for health care are asking provider organizations to adhere to global budgets and risk-sharing arrangements in an effort to control spending and promote value in health care delivery. A Commonwealth Fund–supported survey of 21 large, multispecialty medical groups—often viewed by policymakers as the prototypes for accountable care organizations—assessed the extent to which large medical groups are prepared to participate in these kinds of contracts.

What the Study Found

  • On average, about 25 percent of the groups’ patient care revenue in 2010 came from global capitation contracts and about 9 percent came from partial capitation or shared-risk contracts.
  • Medical groups with larger shares of revenue from risk-bearing contracts were more likely to have salaried physicians, advanced data management capabilities, preferred relationships with efficient specialists, and formal programs to coordinate care for high-risk patients.
  • The surveyed groups predicted that their fee-for-service revenue would decline by 18 percentage points by 2013, with growth expected in shared-savings programs, pay-for-performance contracts, and global capitation.


The authors conclude that medical groups lacking experience with risk-sharing contracts may need to develop new competencies and infrastructure to work successfully under them. These include: information systems that track performance and support clinicians in delivering effective care; physician-level reward systems tied to organizational goals; physician leadership; and organizational commitment to performance improvement.

Publication Details



R. Mechanic and D. E. Zinner, “Many Large Medical Groups Will Need to Acquire New Skills and Tools to Be Ready for Payment Reform,” Health Affairs, Sept. 2012 31(9):1984–92.