I have always thought that at least in urban areas, a cooperative team of a healthcare system, physician networ and an insurer could band together to offer coordinated healthcare. A lot of barriers would have to be broken down to make this happen and unfortunately the government seems to be in the business of erecting barriers to cooperative healthcare rather than breaking the barriers down. Incentives would have to be aligned and that would take some doing. I have seen this happen on a smaller scale when physicians buy a hospital or invest in surgery centers. All of a sudden when it affects their compensation it becomes important to contain cost and improve efficiency.
I also think that a community based longitudinal health record would help tremendously on reducing the cost of care as it would substantially reduce the time spent gathering histories. Again interoperability barriers would have to come down. The government hasn't been able to accomplish this but it makes so much sense for all. Operational money is usually the downfall.
Enough ramblings for now.