Here's the pertinent part:
What our system needs are more Kaiser, Geisinger, Mayo and Intermountain health systems. These are the integrated delivery systems that are already delivering higher quality and lower costs. But the Medicare and Medicaid programs have been no more successful than private insurers in supporting the growth of these organizations. If you want to see real health reform, we need to have incentives to encourage more of these entities to emerge.
It seems to be time to ask the question explicitly. Is it the desire of MA state officials that the rest of the hospitals become integrated systems? (As a side question, how many such systems do you want in the state?) If so, how would you hold them accountable? So far, there is little evidence of governmental ability or political will to do so. Who is creating the policy framework that considers this issue in a manner that goes beyond the structure of reimbursements?
While we are at it, who is looking at the issue of plan design? If you create ACOs, you probably intend to limit consumer choice of physicians and doctors as part of their insurance plans. Do you mean to put the primary care doctors in the middle of that issue, restoring them to the hated "gatekeeper" role we saw during the era of managed care?
Focusing solely on reimbursement models is a recipe for failure. Let's think more broadly.