Commentary: Health care reform and its potential impact on academic medical centers.

President Obama's administration has committed to significant changes in the current health care system to address three issues: access, cost, and quality. Leaders at academic medical centers (AMCs) must acknowledge the root cause of the problems within the current system, recognize potential change initiatives, contemplate the changing role that AMCs will play in the health care system of the future, and begin to adapt and respond. The underlying root cause of the problem with our health care system is excessive costs. Although many factors contribute to excess costs, the most important factor is overuse of expensive modalities. The administration will try to impact change by stressing preventive care, improving medical practice with the purpose of achieving greater value, and changing the reimbursement system from fee for service to other reimbursement approaches that provide greater incentives for more coordinated and integrated systems of care. It is argued in this commentary that ultimately reform will lead to some form of a managed care model with limits on spending. Highly integrated health care systems will be in the best position to produce more efficient care that provides value. The authors posit that AMCs have the unique opportunity of shaping integration in many regions of the country and highlight efforts at the University of Kentucky to develop a health care system to serve the commonwealth. Change is inevitable. Being proactive rather than reactive may be important to secure the future of AMCs.