Bruce Goldberg of Oregon Health and Science University reflects on recent efforts to reform healthcare in his state. According to Goldberg, the Affordable Care Act allowed many uninsured people in Oregon to obtain coverage, but inequities in term of cost and access persist. Goldberg describes his state's development of Coordinated Care Organizations (CCOs), which he says reengineered healthcare to align incentives and create local accountability. The CCO model features a global budgeting mechanism that allows for a fixed 3.4 percent growth rate in healthcare spending. According the Goldberg, the system succeeds at controlling costs while affording caregivers the flexibility they need to make smart investments in primary care and prevention.
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