The point I should have made was that this kind of plan could be easier to implement by those hospitals that have more integration among a variety of parts of the patient care spectrum — because it would be easier to coordinate care based on an annual rate per person if there is an integrated delivery system.

For a place like BIDMC, which is not part of a such an integrated system, it would take an extra effort to negotiate the payment and care system throughout the health care spectrum with a variety of institutions that are independent from us. This would require a new kind of risk-sharing arrangement with non-affiliated hospitals, skilled nursing facilities, and the like.

In contrast, for some other systems in the state — Caritas and Partners come to mind — it might be easier because of common ownership, information systems, and joint contracting among a variety of types of health care providers. That being said, even for them, there would also have to be an underlying risk-sharing agreement that was acceptable among their affiliates.

I apologize, however, for leaving the wrong impression in my initial comment.