Referral patterns under accountable care organizations need to consider factors beyond cost and hard outcomes so that the healthcare industry doesn’t repeat the managed care model of the 1990s that was plagued with issues, including ethically problematic “gag rule” contracts, some of which prevented physicians from referring specialists outside the organization.

That’s the opinion of medical ethics experts at Johns Hopkins University and Brigham and Women's Hospital writing in The New England Journal of Medicine, who argue that the industry needs to learn from the mistakes of managed care.

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