This is a population-based system redesign project that is looking into novel approaches to organizing and incentivizing physician and hospital care in order to improve quality and reduce total cost. The project is supported by the Ministry of Health and Long-Term Care and the Canadian Health Services Research Foundation, and is a collaboration among the CICC, Li Ka Shing Knowledge Institute, Institute for Clinical Evaluative Sciences and Dalla Lana School of Public Health, the lead partner.

Analysis of patient referral patterns in Ontario suggests that there are close to one hundred natural primary care-hospital clusters (multi-specialty physician networks) located across the province where patients regularly go to get care, and only rarely do they get care outside of these clusters. While it is evident that these natural clusters can be organizing structures upon which the province can redesign the delivery system to reduce fragmentation of care, they currently have no real existence outside of what the data show. Providers within each cluster, even though they provide different aspects of care to the same patients, have few mechanisms in place to coordinate care, nor are the administrative, regulatory and incentive structures conducive to these types of interactions. These are the precise issues that the ACO project will investigate, and hope to offer solutions to.