Like many other health care analysts, Harold Miller, executive director of the Center for Healthcare Quality and Payment Reform and president and CEO of the Network for Regional Healthcare Improvement (in Pittsburgh, Pa), believes that America’s healthcare system can deliver on the promise of higher quality, lower costs, and greater patient access. That is, if it can be aligned with a payment structure that rewards care coordination as well as value.

The AAFP online article, “Payment Expert Says Primary Care Physicians Should Drive ACOs,” talks about how Miler is “convinced that primary care physicians, not hospitals, should serve as the core of ACOs.”

According to the article, with ACOs, “once you define how you want patient care to change, you then need to change the payment system to support that; in many cases, current payment systems either don’t pay for the right kind of care or they penalize outsourced physicians, hospital physicians, and hospitals that improve care.”

“There is not a lot to stop hospitals from dominating ACOs unless physicians take the leadership role and say, ‘We’re going to organize and manage the ACO because we are the ones who really define what good patient care is and control what the patients get,’” said Miller.

“However, physician practices face a number of challenges in doing so: They need to have a payment system that will help them make the upfront changes in care for patients, and they will need to join with other practices to form an ACO because they will need to have enough patients to make the finances work,” Miller concluded.