During the past two years, we've heard a lot of rhetoric about the Patient Protection and Affordable Care Act. Regardless of the political battle, one thing is clear: Health care is reforming, with or without the bill Congress passed in March 2010.

It has to. Although health care costs have moderated a bit in the past year—probably due to the weak economy—the big picture hasn't changed. In 2009, the U.S. spent $7,960 per person on medical care. That's more than twice what Canada, Japan, Germany, and even supposedly profligate France spent to care for their citizens. Those costs continue to rise by 7 percent or more each year, far in excess of inflation.

Because of that, in the future, we're going to see a different health care model in the U.S., one where care is based on evidence, where physicians are paid for results, and where people collaborate with their doctors to improve health.

But guess what: The future is here. That's how Group Health Cooperative has practiced medicine since its founding in 1947. We believe our approach to medicine—patient-centered, coordinated, and focused on results—simply works better. That approach can lead the nation toward a model for health care that finally bends the curve of health care costs, without compromising care.

Those aren't just words. We have facts. Take our initiatives around medical home, a term that denotes a particular approach to creating health care partnerships between patients, physicians, and physicians' support staff. Medical home primary care emphasizes smaller physician workloads, longer appointment times, team-based patient support, and electronic medical records to maximize coordination and safety.

At a time when most physicians are allotted only 15 minutes to see a patient, we allow 30. Plus, we give our members around-the-clock telephone access to nurses, e-mail access to physicians, and more.

This all should cost more, right? Wrong. Medical home saves Group Health money and makes members healthier and happier because problems are solved more quickly. Compared with Washington state residents covered by other health plans, our medical home patients have 29 percent fewer emergency-room visits, the most costly kind of visit; experience 11 percent fewer hospitalizations; and overall cost $10 less per member per month than before we adopted medical home.

That's only one example of how Group Health's approach to medicine yields great results. Another is in our care of diabetic patients. Because our members get effective help in managing their disease, they are admitted to a hospital 33 percent less than a national benchmark population. They have fewer complications. And we pay more attention to some hidden effects of diabetes, such as depression.

We do all of this while still spending 14.5 percent less per patient than the average for diabetes patients in Washin-gton state.

But it isn't all just about us. In Spokane, we rely on a network of local physicians to give our members the same kind of care we provide in our own medical centers. We work together to coordinate care for members and to ensure communications between providers and patients.

Our collaboration with Providence Health Care is one example of how we work to provide members with the best possible care—through shared clinical information, joint clinical programs, and adoption of best practices. We believe working with Providence will help solve one of the most vexing problems in health care—uncoordinated care.

Let's say you have a headache. In a typical uncoordinated system, you might see a primary care physician, who in the rush to see patients gives you a quick exam and refers you to a neurologist. But the neurologist might not have an open appointment for two weeks, so in the meantime, the primary care doctor orders up an MRI or other tests that may or may not be needed. The neurologist may never see the patient's original chart or talk to the primary care physician.

How much better it would be if the primary care physician has the time to do a thorough exam, discuss options with a patient, and get input from the neurology specialist in a timely fashion, all while patient charts, radiology images, and other important document are quickly and electronically shared. The patient's outcome is better, and costs almost certainly go down due to less waste.

That's our goal in working with Providence—giving Spokane residents care that's coordinated, not stuck in siloes. This is a collaborative effort—we're learning from the superb physicians at Providence, just as we hope they are learning from us.

We have a lot of initiatives under way. And there is much more that we can do to show physicians and patients what patient-centered care can look like.

But it isn't easy to get our massive health system to change the way it does business. Across the U.S., nearly all physicians work on a fee-for-service basis, meaning they are paid for each test, patient visit, or surgery.

Insurance companies, meanwhile, are accustomed to paying physicians based on that model, so today's regulatory and reimbursement system doesn't support systems such as ours. For example, phone and email consultations have become a popular way patients work with Group Health physicians. We know it reduces unnecessary office visits. But there's no way to bill for it.

We need payment reform that rewards performance rather than volume. There must be an incentive for providing the right care, at the right time, in the right setting.

We're hoping in the next year, government regulators, insurers, and health care providers can have a productive discussion about our national health care model and how it can be made more accountable, coordinated, and effective. We'd like to see broader adoption of payment for results, not tests performed—and a care world where physicians are encouraged to work together to solve problems.