Act of 2003). The program has become known as the 646 Demonstration. The goal of the 646 Demonstration is to improve the "quality of care and services delivered to Medicare beneficiaries through system redesign that fosters best practice…." 1 A competitive process was used to select health care organizations (physician group practices, integrated delivery systems, and regional coalitions of physician group practices and integrated delivery systems) to participate in this five-year demonstration.The Centers for Medicare and Medicaid Services (CMS) intended to use this demonstration to identify, develop, test, and disseminate major and multifaceted improvements to the health care system. Projects approved under the demonstration were expected to implement a plan that would "address gaps in care, quality, and efficiency by combining system redesignimprovements in clinical and non-clinical process and structures within systems and organizations-with payment changes that alter the financial incentives." 1The application process was conducted in two phases.
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