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Policy makers and health care leaders are well aware that despite spending twice as much per capita on health care, the US leads amongst high-income countries in early mortality. Within the US, health disparities are widening and pervasive, with variations in life expectancy present across geographic scales (neighborhoods, counties, and states) and across racial and socioeconomic populations. The crisis of US life expectancy has drawn increasing attention in recent months, with the Washington Post publishing an extensive series and a commentary in the New York Times calling attention to the “scandal” that is US health care, but focusing on how chronic disease is contributing to premature mortality.
We argue here that a complete transition to global payment models, such as those employed by accountable care organizations, combined with a shift to population health-focused performance measures should be used to encourage health care organizations to play a leadership role in improving health and eliminating health inequities within the US population. We take this stance for three reasons. First, life expectancy is powerfully influenced by modifiable clinical and behavioral risk factors that are already the direct responsibility of primary care. Second, providers can improve these if they have the tools, incentives, and flexibility needed to do so, as we discuss below. Third, if sufficiently motivated to improve health, we suggest (with some evidence) that providers can and will reach out to collaborate across sectors to work upstream to improve the vital conditions essential to health and well-being in the communities they serve and advocate for the policy changes required to do so.