February 2012

Document Type


Degree Name



Dept. of Medical Informatics and Clinical Epidemiology


Oregon Health & Science University


Although accountable care may have been around for many years, the concept has moved to the forefront with health reform. Accountable care is care which is measurable and reportable that seeks to foster quality and cost-effective care. Providers should be accountable for the care they provide. Some of the critical aspects of accountable care include patient-centered medical homes, a cross-collaborative team approach to care, and a strong foundation of high-performing primary care. It is important to be able to measure quality, employ evidenced-based medicine in a transparent environment, and to have a robust health IT system, with appropriate use of telemedicine and e health, in a culture of accountability. Much can be learned from a review of some of the major healthcare integrated delivery systems in the United States that practice and excel at accountable care. A number of forms of accountable care are likely to be key to health reform including value-based purchasing, episode-based performance measurement, and payment for quality and improved efficiencies. Accountable care likely will lead to a crossroads in quality, where there will be shared governance, and physician leadership. There will be a performance-based concept of competence with engaged extended hospital medical staffs, and knowledge management. Patients will be engaged to a greater extent in their healthcare. Purchasers of healthcare will adopt new compensation strategies to influence the quality of care. More accountable care systems will emerge, and the Medicare Shared Savings, Accountable Care Organization alternative might be an important one for provider participation. Clinical integration will be important for most successful healthcare systems that want to develop accountable care models. Finally, the principles of biomedical informatics will be a key to accountable care under health reform.




School of Medicine



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