Lessons to apply to national comprehensive healthcare reform.

Fragmentation, insufficient coordination of care, and absence of unified accountability for patient care has resulted in medical errors, rehospitalizations, and preventable complications, all of which increase costs and negatively affect patient outcomes. The current US healthcare system is unsustainable and the national healthcare reform package must address cost containment and quality improvement. Four innovative healthcare models--integrated delivery systems, pay for performance, value-based insurance design, and the medical home--strive to improve quality of care and contain costs. None of these models will solve all healthcare problems alone, nor will they all work everywhere. Different regions, patient populations, and purchaser/payer/provider coalitions may respond to different innovations and modified combinations of the models may eventually predominate. Initial evidence from the Centers for Medicare & Medicaid Services and private sector demonstrations suggests that payment system changes and other innovations would do more than help control runaway healthcare costs. If widely implemented, value-based reforms might achieve long-term improvements in public health. Congress will soon decide whether changing the entire system would be the most value-based reform of all.