grail, the path can be elusive or, at least uncertain. That is clearly the case here. As Art just pointed out, we are looking into the future. We have to keep our eyes on the future very squarely, continuing to look as far beyond the horizon as we can, because things are changing very rapidly and we can’t be held back or held down by perspectives shaped in circumstances today that may not pertain tomorrow.

We have heard a number of very interesting ideas, as well as a number of expressive take-home phrases. I have jotted down a few of them in each of our three categories: care decision strategies, value and quality, and knowledge generation. With respect to care decision strategies, we heard that a meaningful care experience is when someone goes out of their way. We heard “listen first, listen fully.” We heard “patient engagement is a skill, not a trait.” We heard “connectedness and connectivity count.” From one provider, we heard “decision aids save me time.” And we heard that “culture eats strategy for lunch every time.” We have heard that “real innovation is truly disruptive,” and, for us, truly disruptive would be the movement of care choice to the point of the individual. We heard about “the power of distributed leadership.” These concepts shape our thoughts about what we can do with respect to care decision strategies that will improve the future of health and health care.

On the count of value and quality, we heard that “money is a proxy for quality in every industry but health care.” And, of course, that is true. However, we also heard that “wise use of resources resonates with people” and offers a foundation on which we can build. We were advised to let quality lead on value. We heard about the importance of the 3-second rule—“if it’s not engageable in 3 seconds, forget about it”—as a means of motivating change. We heard that absolute dollars register more than dollar signs when conveying information on outcomes and quality and cost. We heard the question, “Who is the trusted translator?” as a very important perspective to bear in mind. We heard that real incentives have feedback loops, and that “getting the dynamic of the feedback loop right is just as important as getting the initial message right.”

In the area of knowledge generation, we heard that “patients represent untapped data streams.” We heard about the “paradox of protection.” In protecting patient privacy and prerogative, we have left patients unprotected with respect to the loss of evidence that otherwise could be generated. We heard that there is little hope of solving the long-term problem without integration of care and learning. We heard that data sharing will drive change, but “data sharing is not sharecropping.” This offers us an important admonition that “permission matters” when we are expanding our ability to mine clinical data. As a nod to the higher calling in knowledge generation, we heard that we owe it to ourselves, to our families, and to society to draw upon this resource for improving the public good in its most fundamental fashion.

From these and many other take-home phrases throughout the course of this workshop, we’ve heard a number of suggestions about what needs to happen as we look to the future with respect to care processes, with respect to scientific insights, and with respect to price, cost, and value. In the care decision arena, we clearly need to focus on ways in which decision aids and decision information can be mobilized and delivered as efficiently as possible. To begin to work on the issues of trust, we need to work on the challenges affiliated with the multiple loci of information that is produced, and improve access to trusted information across the board. Of course, programs like Choosing Wisely are fundamentally important steps in that respect, and there is much more that we can do. We also can explore, it was suggested, possible approaches to shared decision making as a covered benefit. What are the strategies here to provide the economic incentives possible? If we’re really interested in care culture that changes both professional care culture and other elements of the culture that shape our future care delivery



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