Rising health care and health benefits costs for workers and their dependents are negatively impacting the private and public sectors. The cumulative effects are greater un-insurance and under-insurance, disparities in health care benefit based on income, depressed job and wage growth, and the contraction of multiple publicly-funded non-health services. The problem of rising health care costs is particularly acute for low wage workers and their employers. Indeed in 2006 for the first time the average family premium for health insurance will exceed the total amount earned at the federal minumum wage.

Most efforts to reduce the cost of delivering care rely on cost shifting mechanisms or trying to micromanage utilization such as through preauthorization programs. Over the past year we have been developing a wholly new strategy – to make heath care more affordable by fundamentally changing the entire production process of care at the same time- thereby dramatically reducing costs while holding quality constant or likely improving it. As part of a grant funded by the California Health Care Foundation, we have developed a new model of care, called the Ambulatory Intensive Caring Unit (A-ICU), which is built to exclusively serve the 20% highest risk segment of patients, with multiple cost-saving innovations "baked-in" to primary care delivery and referral relationships with high efficiency specialists, hospitals, and other non-primary care service providers. The goal of the A-ICU is to allow "high performing", high risk patients and clinical teams that specialize in high risk patients to attain breakthrough in the affordability of better health care.