1. The secretary should work with Congress to ensure that the department’s programs and reimbursement policies are outcomes-based, reflecting best available evidence of value and creating incentives for adoption of best practices, including integration of care, in order to improve quality and efficiency.

  2. The department should collaborate with state and local public health agencies and community-based organizations, as both sources and users of practical program guidance.

  3. The department should provide authoritative, plain-language, and current evidence-based information to the public regarding prevention and treatment options.

  4. To assess the health of the American people and overall health system performance accurately, the department needs current data from the nation’s health system. To facilitate collection of these data, the department should actively promote the universal adoption of electronic information capabilities—including health information exchange and electronic medical, personal health records—for administrative and clinical purposes.


Medicare and Medicaid exert powerful influence on the U.S. health care system beyond the impact of the large dollars they expend. Because their rules and coverage decisions often are adopted by private payers, these two public programs—although limited to covering specific population groups—affect the entire health care system and all Americans. Also, some of their reimbursement strategies—especially those supporting traditional fee-for-service care—have inadvertently contributed to the rapid growth in health care costs. As the Institute of Medicine (IOM) committee considered its charge to examine how the Department of Health and Human Services (HHS) could be more effective in “advanc-

dissenting opinions, which can be found in Appendix F. They were unable to agree on a common statement.

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