This issue of the journal demonstrates our commitment to recognizing the importance of patient-derived information. The special theme focuses on the Centers for Medicare & Medicaid Services use of the Medical Outcomes Survey in the evaluation of managed care organizations. The second half of this special issue on the Medical Outcomes Survey will appear in the next issue. I welcome readers to submit other ideas on how to incorporate patient-derived information into daily practice. I am particularly focused on patient-derived outcomes information. I was bemused to recently hear a story from a physician colleague who told me that a large health system paid a bonus to primary care physicians solely on whether or not a consumer opened up his or her personal electronic record! Until and unless we become focused on outcomes, the many initiatives, most notably from the Centers for Medicare & Medicaid Services (eg, Value-Based Purchasing or the Premiere Initiative) and National Quality Forum, are likely to face significant challenges. Compare clicking once on your electronic record and a whole host of other similar process measures of questionable relevance with risk-adjusted outcomes such as decreasing complications and admissions to the hospital.

The articles by Gabel and Wise and colleagues speak to the issues of leadership and organization within health care organizations. Emerson and colleagues highlight the ongoing presence of the uninsured in the United States. As all health care professionals know, the recent Supreme Court decision will not ipso facto result in the disappearance of the uninsured; we have a long road ahead. The article by Bernstein and Goldfield offers specific suggestions on how to pay for the newest wrinkle in health care payment-bundled or episode payment. Finally, Mark Holt concludes with the latest from the Republic of Texas.

-Norbert I. Goldfield, MD

Editor