Reforming the health care system in the United States could be more successful if health care delivery was addressed alongside financing health care. The health care delivery system includes hospitals, physician practices, and other organizations and structures that provide patient care.

In this article, an argument is made for accountable care systems (ACSs). The authors detail capabilities ACSs should have in order to enhance health care quality and manage health care costs. Additionally, ACS models are posited with advantages and disadvantages of each reviewed.

Key Findings: 

• Examples of ACS capabilities noted by the authors were redesigning care processes, coordinating care for patients across conditions, services and settings, and being able to adjust to change.
• The ACS could serve as an umbrella for models such as multi-specialty group practice (MSGP), hospital medical staff organization (HMSO), physician-hospital organization (PHO), interdependent physician organization (IPO), and health plan provider organization or network (HPPO/HPPN).
• In order to promote the ACS the authors suggest a National Center for Evidence-Based Medicine and Management; changes in Medicare payment practices; a national performance measurement and accountability system; and an emphasis on information, infrastructure and incentives. 

Health care delivery system reform is integral in addressing the fragmentation that exists in the current health care system. 

Keywords: Delivery Systems, Administrative Cost/Structure, Cost Effectiveness