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Health System Change

  • Cornerstone: The Rise and Fall of a Health Care Experiment: New York Times by Reed Abelson—HIGH POINT, N.C.—Cornerstone Health Care, a large physician group here, made a big bet a few years back: It would get paid based not on how many procedures its doctors performed, but on how effectively they treated their patients. There’s a term for this: an accountable care organization. The idea is to make doctors more mindful of costs—Is that test really necessary?—while keeping people healthier and away from pricey hospital visits. In recent years, several hundred accountable care experiments have sprung up nationwide. And by early 2015, Cornerstone’s bet looked like a winner. But the confirmation proved premature. Within weeks of Ms. Burwell’s announcement, an exodus of doctors had begun at Cornerstone. In the months that followed, nearly 70 of its 228 doctors left, many attracted by the chance to make more money at area hospitals. Cornerstone’s experience illuminates just how tough it can be to overhaul the way medical care is delivered, even when the change is a priority for doctors and the government. As Cornerstone learned, hospitals and doctors frequently fight the changes, because they believe they can make the most money under a fee-for-service model.

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