For Robert Pearl, M.D., accountable care-a delivery model in which providers are rewarded on outcomes, not volume-is an idea whose time has come.

"Health care is fragmented and it resembles a 19th century cottage industry more than an integrated delivery system," says Pearl, chairman of the Council of Accountable Physician Practices, an offshoot of the American Medical Group Association. Doubling as CEO of the Oakland, Calif.-based Permanente Medical Group, Pearl says the council's 30-plus large group practices-spanning such disparate locales as rural Montana and urban Massachusetts-face multiple common challenges in fulfilling the care coordination underpinnings of accountable care.

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