A ruling by the Internal Revenue Service (IRS) creates a significant obstacle to a new type of health care network that the Obama administration has promoted as a way to provide better care at lower cost, at least according industry lawyers and providers. Health care markets are rapidly changing as independent doctors and hospitals race to form networks, otherwise known as accountable care organizations, in which they coordinate care for patients. The doctors and hospitals have financial incentives to keep patients healthy and to control costs, and they can share in the savings if they meet performance goals. The new entities, which now cover more than 28 million people, according to Leavitt Partners, help manage care for Medicare beneficiaries, people with employer-sponsored insurance, and consumers who buy coverage through online marketplaces under the Affordable Care Act.

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