Is it worth the effort to create a learning healthcare delivery system?

Background: US health care is fragmented by a lack of uniform effective care and a fee-for-service payment system. Fee-for-service is a factor in the high cost of health care in the US, and pay-for-performance systems may be a more manageable method for payment to control costs and manage quality. Payment systems: Pay-for-performance would mean that payments are no longer made on a case-by-case basis, but in 'global payments' to overseeing bodies known as accountable care organizations (ACOs). Accountable Care: If concepts such as the arrangement of ACOs work under the Affordable Care Act, then there is hope that national levels for the uninsured will mimic the improvements in Massachusetts in the past decade. ACOs are the next step under reform, but where are we really headed? Historically, difficult economic times have resulted in pooling of health services to develop integrated delivery systems such as the Mayo Clinic and Kaiser Permanente. Integrated delivery systems streamline care by better directing the care of the patient through an autonomous system rather than through costly, fragmented and often unnecessary care. These systems learn from their strengths and weaknesses, and improve access of patients to the proper modalities of care on a timely basis. The US has an excellent opportunity to achieve expanded health coverage and reform of the delivery system in this manner. Conclusions: Ultimately, ACOs are capable of starting America down a path towards universal health care by shaping organizations of providers, but time will present a greater picture of whether the US can adopt this framework.