Before alignment

With demonstration grants in Colorado, Oklahoma, New Mexico and Texas, The Center for Medicare and Medicaid Services (CMS) has stimulated our thinking about global payment and how physicians and hospital administrators can share one check. I cringe each time I hear, "We need to align our doctors...," because, as a fellow surgeon confided to me, "The hammer remains unchanged, but the nail gets pounded!"

We need to step back a moment, reflect on the desired end state, where we collaborate to improve clinical and financial outcomes and consider what we need to do to arrive there. Cultural change embodies personal change, wherein lies the rub.

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