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There is much buzz in the health care field about moving to a value-based purchasing/pay-for-performance system rather than a fee-for-service system. In other words, providers would be rewarded for how well they provide services and obtain better patient outcomes, not by how many services are provided, as is the current usual payment structure. This basic premise drove many of the provisions of the Patient Protection and Affordable Care Act (PPACA). It is this premise that is the root of the accountable care organization (ACO) idea, about which we have written several times.

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