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The vice president of an innovative community hospital is proposing a plan focusing upon family practitioners to deliver an integrated health delivery system. A key issue is how to alter the incentive/compensation plan from fee-for-service (ie, piece rates) to a schedule based on capitation (ie, guaranteed income based on serving all the health needs of a defined population). The teaching purposes are: (1) to examine change management issues in a very complex, political environment involving professionals; and (2) to develop appropriate metrics of physician accountability.