Medical care is intended to help people …

There's no denying health care is big business. But the big payoff should be focused on patients.

In a July 4 op-ed in the New York Times, H. Gilbert Welch, MD, MPH, professor of medicine at Dartmouth's Geisel School of Medicine and an author on health care ethics, posited whether health care's current business model borders on "criminal."

"Medical care is intended to help people, not enrich providers. But the way prices are rising, it’s beginning to look less like help than like highway robbery. And the providers — hospitals, doctors, universities, pharmaceutical companies and device manufacturers — are the ones benefiting."

Dr. Welch points to recent media coverage, such as Time magazine's 36-page cover story "Bitter Pill" (March 4, 2013), that shows pricing disparities and how consolidation has increased costs, notably to those who can least afford to pay them.

One area of concern is the acquisition of physician practices by hospitals and health systems. Is this motivated by money (hospital-owned physician practices get higher reimbursements) or achieving the Triple Aim (higher quality, lower cost and better patient experience)?

Probably both.

There are growing examples that show the acquisition of physician practices by hospitals has resulted in more tests and higher costs (Dr. Welch gives a few examples). There is also plenty of promise of better coordinated medical care through disease management and improved patient engagement.

But what is clearly evident — especially in areas where "integrated" health systems are truly integrated (think Kaiser Permanente) — is that care can improve when everyone is working collaboratively toward the patient's well-being.

Dr. Welch had another poignant line:

"… what happened to the word 'community' next to the word 'hospital?'"

By building a truly integrated system — from physicians to hospitals to community wellness programs — we can again focus on improving the health and well-being of our communities and reserve the medical part of the system to take care of those who genuinely need it.

That's accountable care — being accountable to the community you serve and the patients who put their trust in you.