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A new vision and leadership challenge: implementing the Affordable Care Act to improve the organization and delivery of health care services.

America’s unsustainable growth of health care expenditures is inextricably linked to the country’s economy. With estimates of health care spending projected to reach $5.0 trillion or 20% of the GDP by 2021, health care spending may well be the anchor that brings the economic ship to a grinding halt. Large discrepancies become apparent when spending levels on a per capita basis and outcomes are compared between the United States and other developed countries. These data not only shed light on the differences but also provide an opportunity to consider those factors behind higher costs and lower-quality scores. The structure and processes of care in the United States hold clues to the relative lack of efficiency and effectiveness of the US health care system. Since the advent of private health insurance in the early part of the 20th century, the means by which health services are paid in the United States promoted the development of a highly fragmented, illness-focused delivery system. Until only very recently, payment models that encourage collaboration, healthy behaviors, a focus on total cost of care, chronic disease management, and outcomes were largely nonexistent in the mainstream of the US health care system. The impact of the fee-for-service (FFS) payment model as a significant contributor behind the escalating cost of health care could be observed during the Great Recession (2007-2009). Martin and colleagues reported