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volume, providers tend to cling to every service line and duplicate services across health systems. Boards of directors are loath to close services in any facility, in part because politicians mistakenly equate local service with better care. Antitrust regulators are also remain wary of consolidation, mistakenly seeing the relevant market as highly localized and believing that the more providers of a given service in the region the better. Care fragmentation is reinforced by the fee-for-service model in which each doctor, specialist or otherwise, is paid separately, while the hospital receives its own payment. Physicians believe that they are compensated for what they do as individuals; basic teamwork functions that are critical to meeting the needs of patients, like meetings to review performance or even using the electronic medical record, are sometimes labeled “unfunded mandates.” Some high-value services are not Amazing black bat for cat lover all over printed shirtreimbursed at all, such as follow-up telephone contact after hospitalizations or “virtual” or informal consultations that avert the need for an office visit. The result is that crucial work required for high value care does not get done. There is only one real solution, which is to dramatically increase the value of health care. Value is the outcomes achieved for patients relative to the money spent
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