Passage of legislation alone will not lead to fundamental change in the health care enterprise. The legislation will have to be carefully implemented to better orient health care toward science and value. These reforms are an ongoing process and will evolve over time in response to changing national conditions.

Federal and state government actions are complemented by multiple initiatives on the part of employers, specialty societies, patient and consumer groups, health care delivery organizations, health plans, and others seeking to improve the health care system:

  • In 2012, the American Board of Internal Medicine (ABIM), along with nine other specialty societies, released its Choosing Wisely campaign, focused on reducing overuse of specific medical tests or procedures in different health care specialties (Cassel and Guest, 2012). The first stage of the campaign, piloted by the National Physicians Alliance, developed a list for use by primary care practitioners to promote the more effective use of health care resources (Good Stewardship Working Group, 2011); current initiatives are working to expand this list to additional medical specialties.
  • Drawing on their experiences in improving outcomes and lowering costs through initiatives in their own institutions, a group of health care delivery leaders has developed “A CEO Checklist for High-Value Health Care,” which describes system-change approaches that can be adopted in most health care settings to improve outcomes and reduce costs of care (Cosgrove et al., 2012) (Appendix B).
  • The Patient-Centered Primary Care Collaborative is an initiative that seeks to spread patient-centered medical homes.
  • Other innovative approaches are being explored by partnerships among health systems, employers, payers, and other key stakeholders. In 2004, for example, Virginia Mason negotiated an arrangement with Aetna by which Virginia Mason production system’s lean methods would be used to provide care more efficiently in exchange for Aetna’s providing analyses of claims data to support the endeavor. Four major employers in the Seattle market—Costco, Starbucks, King Country, and Nordstrom—also participated, each choosing a condition prevalent among their workforces on which Virginia Mason should concentrate its efforts to deliver high-value care (Ginsburg et al., 2007; Pham et al., 2007).
  • In Wisconsin, two multistakeholder groups—the Wisconsin Collaborative for Healthcare Quality and the Wisconsin Health Information Organization—work to collect, measure, and report health

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