The Opportunities and Challenges of a Lifelong Health System

In this commentary, Neal Halfon and Patrick Conway, argue that the main challenge to creating a lifelong health system lies in moving from a fee-for-service model to paying for value and better outcomes over the long term. They examine two approaches used in other markets to manage risks and returns over long time frames that may be applicable in health care- warranties and trusts.

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Halfon N, Conway PH. The Opportunities and Challenges of a Lifelong Health System. N Engl J Med. 2013;368(17):1569-71. Available at

  • Halfon and Conway observe that “ACOs could evolve toward accountable health systems that have a greater stake in long-term population health outcomes.” Unfortunately, that passage stops short of explicitly highlighting the potential for system-wide reinvestment, which is likely to be one way such a “stake” could become real. Nevertheless, this is a useful statement about why a more integrated, long-term approach to system reform could be within reach.