U.S. government has to contend with these challenges while also facing an aging population, many with multiple medical conditions (Martini et al., 2007; Meara et al., 2004; Strunk and Ginsburg, 2002), medical care entitlement payouts of unprecedented and unparalleled cost (Social Security and Medicare Boards of Trustees, 2008), and an underlying absence of a single agreed-upon measure of value in health care.

The need to enhance the value obtained from health care led the Institute of Medicine’s (IOM’s) Roundtable on Value & Science-Driven Health Care to host a workshop entitled “Value in Health Care: Accounting for Costs, Quality, Safety, Outcomes, and Innovation,” part of the Learning Healthcare System series, in November 2008. Through a multistakeholder forum for discussion of key perspectives on measuring and improving value in health care, presenters and attendees identified the key barriers, opportunities, and next steps necessary to improve value in health care in the United States.

Presenters at this workshop specifically discussed various approaches to assessing and improving value, in terms of both maximizing what we gain in patient outcomes and minimizing what we give up, especially the opportunity costs of expenditures on less effective treatments. The sessions also addressed a number of new and promising tools and organizational arrangements currently being used in the United States in an attempt to increase value, as well as both near-term opportunities and long-term strategies to align the many elements of the healthcare system to promote value. The chapters in this report highlight common themes from the discussions and provide summaries of the presentations from a variety of perspectives.

The principal purpose of each of the 8 Roundtable workshops and reports so far is to establish a conceptual framework within which to consider important dimensions of a value-driven health system and to develop an agenda for action to facilitate moving forward. In the three years since the Roundtable was established, the calls for increasing health system value have increased, in large part because of growing evidence that continuing to provide health services in the way we currently do is financially unsustainable and does not result in optimal patient outcomes (Fisher et al., 2003; Peterson and Burton, 2007). The following summary of a keynote address by David M. Walker of the Peter G. Peterson Foundation eloquently expresses the bleak financial trajectory of current healthcare spending in the United States and its implications for the future welfare of the American people and provides the economic and financial context driving the need for action.



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