This issue of The Journal of Ambulatory Care Management highlights in a variety of ways the nexus between risk adjustment and the relationship between different types of providers. Most importantly, John Neff from the University of Washington/Seattle Children's has organized a set of articles that discuss chronic care case management and pediatrics from a variety of perspectives.

Starfield et al expand on our conversation about the relationship between specialists and primary care physicians. Yasaitis and colleagues provide a commentary on this important topic.

Selim and colleagues continue the conversation on risk adjustment by comparing the use of patient-derived measures for risk adjustment and relating the measures to mortality among VA enrollees in private versus the VA system.

There is a continual cacophony of voices on the next best steps on payment reform. Some groups, such as MedPAC, are pushing for an evolutionary path that begins with payment incentives to decrease readmissions, whereas others are pushing for return to global payment-typically in some form of capitation. If one were to implement a payment incentive to decrease readmissions, Averill et al posit a next step-an episode-bundling approach that combines hospital payment together with the physician portion and include, for example, 60 days pre- and postdischarge.

In all these conversations regarding policy/payment questions, it often seems that we are losing sight of the fact that medical care deals with human beings. In an effort to highlight important recent conferences, the Erice Group provides a summary of a meeting on humanization of medical care, particularly as it pertains to oncology.

Finally, we continue with our regular columns pertaining to the Republic of Texas and management in the ambulatory care setting.

Norbert Goldfield, MD

Editor