Inkwell: Authors and Artists

    
We actually have been having quite a discussion on this very matter
elsewhere on the Well. Short version: The devil is in the details, not
only the details of just who is paying for what and how they are
measuring what they are paying for, but the culture of the providers.
It is worth noting that _all_ of the organizations that these new
structures and deals are modeled after (Kaiser, Group Health of Puget
Sound, Mayo, Geisinger, Cleveland Clinic, Bozeman Clinic) differ in
details of structure and payment but have one thing in common: They are
old. The youngest ones are about 60 years old, the oldest (Mayo) more
than 100. The clinicians working in them have self-selected and been
selected to fit that highly collegial culture. How that will work  out
with clinicians and in environments that did not select out that way
will be a matter of great interest and difficulty in the coming years.
But it simply must be done. 
  

    
I agree with you, changes are essential and these models not only work
well but deliver better quality health care for their participants. 
Let's hope that other organizations see their way clear to adopt  the
best  features and make the changes necessary to provide affordable,
patient-centered care going forward.