To assist purchasers in the redesign of payment policy based on these fundamental principles, a vigorous program of pilot testing and evaluating alternative design options should be pursued.

Recommendation 11: The Health Care Financing Administration and the Agency for Healthcare Research and Quality, with input from private payers, health care organizations, and clinicians, should develop a research agenda to identify, pilot test, and evaluate various options for better aligning current payment methods with quality improvement goals.

Examples of possible means of achieving this end include blended methods of payment for providers, multiyear contracts, payment modifications to encourage use of electronic interaction among clinicians and between clinicians and patients, risk adjustment, bundled payments for priority conditions, and alternative approaches for addressing the capital investments needed to improve quality.

Preparing the Workforce

A major challenge in transitioning to the health care system of the 21st century envisioned by the committee is preparing the workforce to acquire new skills and adopt new ways of relating to patients and each other. At least three approaches can be taken to support the workforce in this transition. One is to redesign the way health professionals are trained to emphasize the aims for improvement set forth earlier, including teaching evidence-based practice and using multidisciplinary approaches. Second is to modify the ways in which health professionals are regulated to facilitate the needed changes in care delivery. Scope-of-practice acts and other workforce regulations need to allow for innovation in the use of all types of clinicians to meet patient needs in the most effective and efficient way possible. Third is to examine how the liability system can constructively support changes in care delivery while remaining part of an overall approach to accountability for health care professionals and organizations. All three approaches are important and require additional study.

Recommendation 12: A multidisciplinary summit of leaders within the health professions should be held to discuss and develop strategies for (1) restructuring clinical education to be consistent with the principles of the 21st-century health system throughout the continuum of undergraduate, graduate, and continuing education for medical, nursing, and other professional training programs; and (2) assessing the implications of these changes for provider credentialing programs, funding, and sponsorship of education programs for health professionals.

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