Capital will be required to invest in enhancing organizational capacity, building an information infrastructure, and training multidisciplinary care teams, among other things. The committee believes it is appropriate for the public sector to take the lead in establishing an innovation fund to seed promising projects, but not to shoulder the full burden of the transition. Private-sector organizations, including foundations, purchasers, health care organizations, and others, should also make investments. High priority should be given to projects that are likely to result in making available in the public domain new programs, tools, and technologies that are broadly applicable throughout the health care sector.

Americans now invest annually $1.1 trillion, or 13.5 percent, of the nation’s gross domestic product (GDP) in the health care sector (Health Care Financing Administration, 1999). This figure is expected to grow to more than $2 trillion, or 16 percent of GDP, by 2007 (Smith et al., 1998). The committee believes a sizable commitment, on the order of $1 billion over 3 to 5 years, is needed to strongly communicate the need for rapid and significant change in the health care system and to help initiate the transition. Just as a vigorous public commitment has led to the mapping of human DNA, a similar commitment is needed to help the nation’s health care system achieve the aims for improvement outlined above.

Supporting front-line teams that deliver care are many types of health care organizations. Today, these are hospitals, physician practices, clinics, integrated delivery systems, and health plans, but new forms will unquestionably emerge. Whatever those forms, care that is responsive to patient needs and makes consistent use of the best evidence requires far more conscious and careful organization than we find today.

Organizations will need to negotiate successfully six major challenges. The first is to redesign care processes to serve more effectively the needs of the chronically ill for coordinated, seamless care across settings and clinicians and over time. The use of tools to organize and deliver care has lagged far behind biomedical and clinical knowledge. A number of well-understood design principles, drawn from other industries as well as some of today’s health care organizations, could help greatly in improving the care that is provided to patients.