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While the United States spends more of its gross domestic product on health care than other high-income countries in the world, Americans do not have more affordable or more accessible care. Life expectancy in the U.S. is also lower compared to peer countries, and rates of avoidable deaths are higher.
The predominance of fee-for-service payment in the U.S. is seen as a major contributor to this incongruity. Because health care providers are paid for each service they deliver, fee-for-service incentivizes the delivery of a high volume of services, regardless of their value, efficiency, or quality. Value-based care — which ties payments to patient outcomes rather than the number of services — is a potential tool for improving care quality and equity while also reducing costs.
One of the most promising models of value-based care with the highest participation among health systems and providers is the accountable care organization (ACO). ACOs are networks of providers that join together to assume responsibility for the cost and quality of care delivered to their patients. If they are successful in improving care delivery without increasing costs, providers can receive financial rewards from payers. Many types of providers participate in ACOs, including community health centers (CHCs), which predominately serve low-income and publicly insured or uninsured patients.