A FEW WORDS ABOUT THIS ISSUE

This issue of the journal focuses on a theme that we will continue to return to and comes under the guise of many terms. In this issue, the term is "systemness."

At this point, most people agree that with the reelection of President Obama, we are going down a health policy path that is changing the health care system. The path is composed of several trends occurring simultaneously:

* Pilot experimentation, with, for example, Centers for Medicare & Medicaid Services funding, hundreds of pilot efforts in medical homes, accountable care, and dual eligibles/other groups of individuals who incur the greatest expenses and initiatives to reduce readmissions

* Allowing states flexibility, with the billions coming to enroll uninsured individuals and their families in private or public insurance programs

* An appreciation that patient-centered care as exemplified by "engagement" is important to improve the value of health care

The underlying belief is that this approach will encourage a system-wide rethinking about the entire process of health care delivery. The net effect of the theory is better quality and lower, or at least stabilized, costs. We begin with an introduction by Jeffrey Lerner, an associated editor of this journal and president of ECRI, the premiere organization that researches the best approaches to improving patient care. With his introduction in hand, this issue of the journal highlights many aspects of this effort-ranging from a systematic effort to a change in health care in Oklahoma (L. Carter Kimble and colleagues), rewriting of financial incentives in Texas by the former Texas Medicaid Commissioner (Millwee et al), and an overall approach to changing the system (Moore and DeBuono).

Several other articles (Timimi, De Leon et al, and Sanders et al) revolving around "systemness" highlight other trends, in particular the use of technologies. A particular focus of this journal continues to be on low-income populations and the under-uninsured. The articles by Mehler and colleagues and Nie and colleagues highlight, in both a quantitative and qualitative manner, new modes of delivery (Mehler and colleagues) and new insights into practice patterns (Nie and colleagues) of this population. We again learn the latest from the Republic of Texas, with the latest missive from Dr Mark Holt.

CHANGES FOR FUTURE ISSUES

With a previous issue devoted to patient engagement and this issue devoted to "systemness," we have been signaling a new direction for the Journal of Ambulatory Care Management. New editorial board members will be added to support this change. Moreover, this issue inaugurates a new series that describes the interface between any and every aspect of patient-centered care and technologies/systemness that support patient confidence, activation, and engagement. The articles in the series are called "Snapshots" because they are brief, tightly focused, and timely. We hope that readers will read the invitation to "Snapshots" and consider sharing their "Snapshots" with others.

-Norbert I. Goldfield, MD

Editor