of many types, and that it needs more effective ways to assess its performance, for accountability purposes. Comparative effectiveness analyses fit nicely into this overall learning theme—for both the department and our health system as a whole.
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.
The department has strong relationships with state and local government entities that deliver services and manage programs, and with community-based organizations that are grantees. These groups, too, should align their services with the comparative effectiveness study results, in order to increase system value at the community level. If these entities had appropriate electronic links to the federal government, they could provide real-time feedback to program administrators regarding the functioning of grant and contract programs and their effects on the populations served.
The department should collaborate with state and local public health agencies and community-based organizations, as both sources and users of practical program guidance.
The era when Americans were passive recipients of health services and physicians were unquestioned authorities is fast fading—in part because of societal trends and patients’ own desires, influenced by new