shape and assess options. HHS will want to leverage its relationships with many important constituencies that also can contribute to the reform process.

A successful health reform process would require transparency and strong communication and would undoubtedly be collaborative, cross-governmental, and involve many public- and private-sector entities. The department should clarify its role early in the process and marshal its resources to contribute its unique data resources and the perspectives gained from long and diverse experience.

Specific ways in which the department should participate in a reform process include the following:

• Set up a capacity to quickly conduct or coordinate external research on proposals offered by the White House, Congress, and others.

• Pull together cross-department work teams on key issues as they arise.

• Communicate knowledge to the public about what is known regarding important aspects of reform.

• Organize new forms of demonstration or state waiver programs to test specific aspects of reform proposals.

• Ensure health promotion and disease prevention are adequately included in reform efforts.

• Assess the adequacy of the workforce to support reform proposals.

• Ensure that the new system can be both sustainable and accountable.

• Generally, emphasize creation of more value in the health system.

The combination of a health system that is widely considered fundamentally flawed, competing external demands, internal organizational complexity, and impending large workforce losses due to retirement presents HHS with serious challenges, as well as opportunities for new thinking about the important themes the IOM committee considers in this report: vision, focus, alignment, effectiveness, and accountability.