National Academies Press: OpenBook
Suggested Citation:"Front Matter." Institute of Medicine. 2010. The Healthcare Imperative: Lowering Costs and Improving Outcomes: Workshop Series Summary. Washington, DC: The National Academies Press. doi: 10.17226/12750.
×

THE LEARNING HEALTH SYSTEM SERIES

THE HEALTHCARE IMPERATIVE

Lowering Costs and Improving Outcomes

Workshop Series Summary

Pierre L. Yong, Robert S. Saunders, and LeighAnne Olsen, Editors

ROUNDTABLE ON VALUE & SCIENCE-DRIVEN HEALTH CARE

INSTITUTE OF MEDICINE
OF THE NATIONAL ACADEMIES

THE NATIONAL ACADEMIES PRESS

Washington D.C.
www.nap.edu

Suggested Citation:"Front Matter." Institute of Medicine. 2010. The Healthcare Imperative: Lowering Costs and Improving Outcomes: Workshop Series Summary. Washington, DC: The National Academies Press. doi: 10.17226/12750.
×

THE NATIONAL ACADEMIES PRESS
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NOTICE: The project that is the subject of this report was approved by the Governing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine.

This project was supported by the Peter G. Peterson Foundation. Any opinions, findings, conclusions, or recommendations expressed in this publication are those of the author(s) and do not necessarily reflect the view of the organizations or agencies that provided support for this project.

International Standard Book Number-13: 978-0-309-14433-9

International Standard Book Number-10: 0-309-14433-7

Additional copies of this report are available from the

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For more information about the Institute of Medicine, visit the IOM home page at: www.iom.edu.

Copyright 2010 by the National Academy of Sciences. All rights reserved.

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The serpent has been a symbol of long life, healing, and knowledge among almost all cultures and religions since the beginning of recorded history. The serpent adopted as a logotype by the Institute of Medicine is a relief carving from ancient Greece, now held by the Staatliche Museen in Berlin.

Suggested citation: IOM (Institute of Medicine). 2010. The Healthcare Imperative: Lowering Costs and Improving Outcomes: Workshop Series Summary. Washington, DC: The National Academies Press.

Suggested Citation:"Front Matter." Institute of Medicine. 2010. The Healthcare Imperative: Lowering Costs and Improving Outcomes: Workshop Series Summary. Washington, DC: The National Academies Press. doi: 10.17226/12750.
×

“Knowing is not enough; we must apply.

Willing is not enough; we must do.”

—Goethe

INSTITUTE OF MEDICINE
OF THE NATIONAL ACADEMIES

Advising the Nation. Improving Health.

Suggested Citation:"Front Matter." Institute of Medicine. 2010. The Healthcare Imperative: Lowering Costs and Improving Outcomes: Workshop Series Summary. Washington, DC: The National Academies Press. doi: 10.17226/12750.
×

THE NATIONAL ACADEMIES

Advisers to the Nation on Science, Engineering, and Medicine


The National Academy of Sciences is a private, nonprofit, self-perpetuating society of distinguished scholars engaged in scientific and engineering research, dedicated to the furtherance of science and technology and to their use for the general welfare. Upon the authority of the charter granted to it by the Congress in 1863, the Academy has a mandate that requires it to advise the federal government on scientific and technical matters. Dr. Ralph J. Cicerone is president of the National Academy of Sciences.


The National Academy of Engineering was established in 1964, under the charter of the National Academy of Sciences, as a parallel organization of outstanding engineers. It is autonomous in its administration and in the selection of its members, sharing with the National Academy of Sciences the responsibility for advising the federal government. The National Academy of Engineering also sponsors engineering programs aimed at meeting national needs, encourages education and research, and recognizes the superior achievements of engineers. Dr. Charles M. Vest is president of the National Academy of Engineering.


The Institute of Medicine was established in 1970 by the National Academy of Sciences to secure the services of eminent members of appropriate professions in the examination of policy matters pertaining to the health of the public. The Institute acts under the responsibility given to the National Academy of Sciences by its congressional charter to be an adviser to the federal government and, upon its own initiative, to identify issues of medical care, research, and education. Dr. Harvey V. Fineberg is president of the Institute of Medicine.


The National Research Council was organized by the National Academy of Sciences in 1916 to associate the broad community of science and technology with the Academy’s purposes of furthering knowledge and advising the federal government. Functioning in accordance with general policies determined by the Academy, the Council has become the principal operating agency of both the National Academy of Sciences and the National Academy of Engineering in providing services to the government, the public, and the scientific and engineering communities. The Council is administered jointly by both Academies and the Institute of Medicine. Dr. Ralph J. Cicerone and Dr. Charles M. Vest are chair and vice chair, respectively, of the National Research Council.


www.national-academies.org

Suggested Citation:"Front Matter." Institute of Medicine. 2010. The Healthcare Imperative: Lowering Costs and Improving Outcomes: Workshop Series Summary. Washington, DC: The National Academies Press. doi: 10.17226/12750.
×

ROUNDTABLE ON VALUE & SCIENCE-DRIVEN HEALTH CARE1

Denis A. Cortese (Chair), Emeritus President and Chief Executive Officer,

Mayo Clinic;

Foundation Professor,

ASU

Donald Berwick, Administrator,

Centers for Medicare & Medicaid Services (ex officio)

David Blumenthal, National Coordinator,

Office of the National Coordinator for Health IT (ex officio)

Bruce G. Bodaken, Chairman, President, and Chief Executive Officer,

Blue Shield of California

David R. Brennan, Chief Executive Officer,

AstraZeneca PLC

Paul Chew, Chief Science Officer and CMO,

sanofi-aventis U.S., Inc.

Carolyn M. Clancy, Director,

Agency for Healthcare Research and Quality (ex officio)

Michael J. Critelli, Former Executive Chairman,

Pitney Bowes, Inc.

Helen Darling, President,

National Business Group on Health

Thomas R. Frieden, Director,

Centers for Disease Control and Prevention (designee: Chesley Richards) (ex officio)

Gary L. Gottlieb, President and CEO,

Partners HealthCare System

James A. Guest, President,

Consumers Union

George C. Halvorson, Chairman and Chief Executive Officer,

Kaiser Permanente

Margaret A. Hamburg, Commissioner,

Food and Drug Administration (ex officio)

Carmen Hooker Odom, President,

Milbank Memorial Fund

Ardis Hoven, Professor of Medicine,

University of Kentucky; Chair-elect, American Medical Association

Brent James, Chief Quality Officer and Executive Director,

Institute for Health Care Delivery Research, Intermountain Healthcare

Michael M. E. Johns, Chancellor,

Emory University

Craig Jones, Director,

Vermont Blueprint for Health

Cato T. Laurencin, Vice President for Health Affairs,

Dean of the School of Medicine, University of Connecticut

Stephen P. MacMillan, President and Chief Executive Officer,

Stryker

Mark B. McClellan, Director,

Engelberg Center for Healthcare Reform, The Brookings Institution

Sheri S. McCoy, Worldwide Chairman,

Johnson & Johnson Pharmaceuticals Group

Elizabeth G. Nabel, President,

Brigham and Women’s Hospital

1

Formerly the Roundtable on Evidence-Based Medicine. IOM forums and roundtables do not issue, review, or approve individual documents. The responsibility for the published workshop summary rests with the workshop rapporteurs and the institution.

Suggested Citation:"Front Matter." Institute of Medicine. 2010. The Healthcare Imperative: Lowering Costs and Improving Outcomes: Workshop Series Summary. Washington, DC: The National Academies Press. doi: 10.17226/12750.
×

Mary D. Naylor, Professor and Director of Center for Transitions in Health,

University of Pennsylvania

Peter Neupert, Corporate Vice President,

Health Solutions Group, Microsoft Corporation

Nancy H. Nielsen, Past President,

American Medical Association

William D. Novelli, Former CEO,

AARP;

Professor,

Georgetown University

Jonathan B. Perlin, Chief Medical Officer and President,

Clinical Services, HCA, Inc.

Robert A. Petzel, Under Secretary,

Veterans Health Administration (ex officio)

Richard Platt, Professor and Chair,

Harvard Medical School and Harvard Pilgrim Health Care

John C. Rother, Group Executive Officer,

AARP

John W. Rowe, Professor,

Mailman School of Public Health, Columbia University

Susan Shurin, Acting Director,

National Heart, Lung, and Blood Institute (ex officio)

Mark D. Smith, President and CEO,

California HealthCare Foundation

George P. Taylor, Assistant Secretary for Health Affairs (Acting),

Department of Defense (designee: Michael Dinneen) (ex officio)

Reed D. Tuckson, Executive VP and Chief of Medical Affairs,

UnitedHealth Group

Frances M. Visco, President,

National Breast Cancer Coalition

Workshop Planning Committee

Arnold Milstein (Chair),

Pacific Business Group on Health

Kathleen Buto,

Johnson & Johnson

Robert S. Galvin,

Global Healthcare/General Electric

Paul B. Ginsburg,

Center for Studying Health System Change

Eric Jensen,

McKinsey Global Institute

James Mathews,

Medicare Payment Advisory Commission

Nancy H. Nielsen,

American Medical Association

Steven D. Pearson,

Institute for Clinical and Economic Review

Gail Shearer,

Consumers Union

Reed V. Tuckson,

UnitedHealth Group

Roundtable Staff

Christie Bell, Financial Associate

Patrick Burke, Financial Associate (through December 2009)

Jane Fredell, Program Assistant (through September 2009)

China Dickerson, Program Assistant (through November 2009)

Suggested Citation:"Front Matter." Institute of Medicine. 2010. The Healthcare Imperative: Lowering Costs and Improving Outcomes: Workshop Series Summary. Washington, DC: The National Academies Press. doi: 10.17226/12750.
×

Chanda Ijames, Program Assistant (through December 2009)

J. Michael McGinnis, Senior Scholar and Executive Director

Claudia Grossmann, Program Officer

LeighAnne Olsen, Program Officer (through June 2010)

Brian Powers, Program Assistant

Robert Saunders, Program Officer

Pierre L. Yong, Program Officer (through May 2010)

Kate Vasconi, Senior Program Assistant

Catherine Zweig, Senior Program Assistant (through June 2010)

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Reviewers

This report has been reviewed in draft form by individuals chosen for their diverse perspectives and technical expertise, in accordance with procedures approved by the National Research Council’s Report Review Committee. The purpose of this independent review is to provide candid and critical comments that will assist the institution in making its published report as sound as possible and to ensure that the report meets institutional standards for objectivity, evidence, and responsiveness to the study charge. The review comments and draft manuscript remain confidential to protect the integrity of the process. We wish to thank the following individuals for their review of this report:

Helen Darling, National Business Group on Health

Robert S. Mecklenberg, Virginia Mason Medical Center

Sheila Smith, Office of the Actuary

Sean Tunis, Center for Medical Technology Policy

Although the reviewers listed above have provided many constructive comments and suggestions, they were not asked to endorse the final draft of the report before its release. The review of this report was overseen by Floyd Bloom. Appointed by the National Research Council and the Institute of Medicine, he was responsible for making certain that an independent examination of this report was carried out in accordance with institutional procedures and that all review comments were carefully considered. Responsibility for the final content of this report rests entirely with the editors and the institution.

Suggested Citation:"Front Matter." Institute of Medicine. 2010. The Healthcare Imperative: Lowering Costs and Improving Outcomes: Workshop Series Summary. Washington, DC: The National Academies Press. doi: 10.17226/12750.
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×

Institute of Medicine

Roundtable on Value & Science-Driven Health Care1

Charter and Vision Statement


The Institute of Medicine’s Roundtable on Value & Science-Driven Health Care has been convened to help transform the way evidence on clinical effectiveness is generated and used to improve health and health care. Participants have set a goal that, by the year 2020, 90 percent of clinical decisions will be supported by accurate, timely, and up-to-date clinical information, and will reflect the best available evidence. Roundtable members will work with their colleagues to identify the issues not being adequately addressed, the nature of the barriers and possible solutions, and the priorities for action, and will marshal the resources of the sectors represented on the Roundtable to work for sustained public-private cooperation for change.


******************************************


The Institute of Medicine’s Roundtable on Value & Science-Driven Health Care has been convened to help transform the way evidence on clinical effectiveness is generated and used to improve health and health care. We seek the development of a learning health system that is designed to generate and apply the best evidence for the collaborative healthcare choices of each patient and provider; to drive the process of discovery as a natural outgrowth of patient care, and to ensure innovation, quality, safety, and value in health care.

Vision: Our vision is for a healthcare system that draws on the best evidence to provide the care most appropriate to each patient, emphasizes prevention and health promotion, delivers the most value, adds to learning throughout the delivery of care, and leads to improvements in the nation’s health.

Goal: By the year 2020, 90 percent of clinical decisions will be supported by accurate, timely, and up-to-date clinical information, and will reflect the best available evidence. We feel that this presents a tangible focus for progress toward our vision, that Americans ought to expect at least this level of performance, that it should be feasible with existing resources and emerging tools, and that measures can be developed to track and stimulate progress.

Context: As unprecedented developments in the diagnosis, treatment, and long-term management of disease bring Americans closer than ever to the promise of personalized health care, we are faced with similarly unprecedented challenges to identify and deliver the care most appropriate for individual needs and conditions. Care that is important is often not delivered. Care that is delivered is often not important. In part, this is due to our failure to apply the evidence we have about the medical care that is most effective—a failure related to shortfalls in provider knowledge and accountability, inadequate care coordination and support, lack of insurance, poorly aligned payment incen

1

Formerly the Roundtable on Evidence-Based Medicine.

Suggested Citation:"Front Matter." Institute of Medicine. 2010. The Healthcare Imperative: Lowering Costs and Improving Outcomes: Workshop Series Summary. Washington, DC: The National Academies Press. doi: 10.17226/12750.
×

tives, and misplaced patient expectations. Increasingly, it is also a result of our limited capacity for timely generation of evidence on the relative effectiveness, efficiency, and safety of available and emerging interventions. Improving the value of the return on our healthcare investment is a vital imperative that will require much greater capacity to evaluate high priority clinical interventions, stronger links between clinical research and practice, and reorientation of the incentives to apply new insights. We must quicken our efforts to position evidence development and application as natural outgrowths of clinical care—to foster health care that learns.

Approach: The IOM Roundtable on Value & Science-Driven Health Care serves as a forum to facilitate the collaborative assessment and action around issues central to achieving the vision and goal stated. The challenges are myriad and include issues that must be addressed to improve evidence development, evidence application, and the capacity to advance progress on both dimensions. To address these challenges, as leaders in their fields, Roundtable members will work with their colleagues to identify the issues not being adequately addressed, the nature of the barriers and possible solutions, and the priorities for action, and will marshal the resources of the sectors represented on the Roundtable to work for sustained public-private cooperation for change.

Activities include collaborative exploration of new and expedited approaches to assessing the effectiveness of diagnostic and treatment interventions, better use of the patient care experience to generate evidence on effectiveness, identification of assessment priorities, and communication strategies to enhance provider and patient understanding and support for interventions proven to work best and deliver value in health care.

Core concepts and principles: For the purpose of the Roundtable activities, we define science-driven health care broadly to mean that, to the greatest extent possible, the decisions that shape the health and health care of Americans—by patients, providers, payers, and policymakers alike—will be grounded on a reliable evidence base, will account appropriately for individual variation in patient needs, and will support the generation of new insights on clinical effectiveness. Evidence is generally considered to be information from clinical experience that has met some established test of validity, and the appropriate standard is determined according to the requirements of the intervention and clinical circumstance. Processes that involve the development and use of evidence should be accessible and transparent to all stakeholders.

A common commitment to certain principles and priorities guides the activities of the Roundtable and its members, including the commitment to: the right health care for each person; putting the best evidence into practice; establishing the effectiveness, efficiency, and safety of medical care delivered; building constant measurement into our healthcare investments; the establishment of healthcare data as a public good; shared responsibility distributed equitably across stakeholders, both public and private; collaborative stakeholder involvement in priority setting; transparency in the execution of activities and reporting of results; and subjugation of individual political or stakeholder perspectives in favor of the common good.

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Suggested Citation:"Front Matter." Institute of Medicine. 2010. The Healthcare Imperative: Lowering Costs and Improving Outcomes: Workshop Series Summary. Washington, DC: The National Academies Press. doi: 10.17226/12750.
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Foreword

Health reform is driven by the needs of the 47 million uninsured in this country and is also propelled by the central issue of cost. Escalating national healthcare expenditures engulf a rapidly enlarging fraction of the federal budget. Businesses pass part of the soaring costs on to their employees in the form of rising health insurance premiums. Families struggle to pay their healthcare bills, and many have delayed seeking necessary and important care.

Since 2006, the Institute of Medicine has assembled the diverse leadership across the health care system—including patient and consumer, provider, manufacturer, payer, research and policy representatives—under the auspices of our Roundtable on Value & Science-Driven Health Care (formerly the Roundtable on Evidence-Based Medicine) to engage the pressing issues confronting the U.S. healthcare delivery system today. Under the guidance of its membership, the Roundtable developed the vision of a learning health system, one in which evidence development is not merely an occasional byproduct of health care, but one in which evidence capture and analysis, as well as its application, is systematically structured as an integral and natural component of the care process. Building on its efforts to enhance the value obtained from health expenditures and with the generous support of the Peter G. Peterson Foundation, the Roundtable convened stakeholders from across the healthcare field in a series of four 2-day meetings, titled The Healthcare Imperative: Lowering Costs and Improving Outcomes. These sessions were devoted to understanding the sources of excess costs in health care, reviewing what is known about ways to reduce the excess, and identifying policy solutions.

Suggested Citation:"Front Matter." Institute of Medicine. 2010. The Healthcare Imperative: Lowering Costs and Improving Outcomes: Workshop Series Summary. Washington, DC: The National Academies Press. doi: 10.17226/12750.
×

This summary highlights the presentations and discussions from these workshops, delving into the major causes of excess spending, waste, and inefficiency in health care; considering the strategies that might reduce per capita health spending in the United States while improving health outcomes and preserving innovation; and exploring the policy options that would facilitate those strategies. The ideas and observations throughout this volume are offered in the belief that health reform, now and in the future, will benefit from identifying actionable options to lower healthcare costs in ways that maximize value.

I would like to extend my personal thanks especially to the Peter G. Peterson Foundation and its President, David Walker, to the Planning Committee assembled for the series, to the Roundtable membership for their continued leadership and commitment to advancing health care in this nation, and to the Roundtable staff for their contributions in coordinating and supporting the meeting series and ongoing Roundtable activities.


Harvey V. Fineberg, M.D., Ph.D.

President, Institute of Medicine

Suggested Citation:"Front Matter." Institute of Medicine. 2010. The Healthcare Imperative: Lowering Costs and Improving Outcomes: Workshop Series Summary. Washington, DC: The National Academies Press. doi: 10.17226/12750.
×

Preface

Stimulated by the challenges facing our nation as healthcare expenditures continue to soar and threaten our fiscal future, the four-part workshop series The Healthcare Imperative: Lowering Costs and Improving Outcomes, supported by the Peter G. Peterson Foundation, explored in detail the sources and implications of waste and excess cost in health care, as well as the strategies and policies necessary to address the issues. This volume summarizes the workshops, which were convened in May, July, September, and December of 2009 by the Institute of Medicine (IOM) Roundtable on Value & Science-Driven Health Care (formerly the Roundtable on Evidence-Based Medicine), as part of its Learning Health System workshop series. These meetings offered a forum for the broad spectrum of stakeholders in health to discuss the range of issues pertinent to reducing health spending without compromising health status, quality of care, or valued innovation. The discussion summary and its related presentations reflect the contributions of experts from multiple sectors involved in leadership, policy, practice, and innovation on behalf of better value in health care.

Guided by its membership, the vision of the IOM Roundtable on Value & Science-Driven Health Care is to catalyze the development of a learning health system—a system in which the processes and systems utilized by the healthcare system enable both the natural delivery of best care practices and the real-time generation and application of new evidence. With the support of senior leadership from the country’s key healthcare sectors, the Roundtable has furthered its vision through collaborative initiatives, including public workshops and published proceedings. This workshop series emerged from prior work of the Roundtable on value in health care,

Suggested Citation:"Front Matter." Institute of Medicine. 2010. The Healthcare Imperative: Lowering Costs and Improving Outcomes: Workshop Series Summary. Washington, DC: The National Academies Press. doi: 10.17226/12750.
×

as well as the ongoing dialogue on healthcare reform, and provided a forum for stakeholders to discuss their perspectives and to identify ideas and areas for further consideration.

The contributions of the workshop discussions to better understanding have been conceptual, quantitative, and qualitative. Conceptually, the approach fashioned by the Planning Committee grouped the sources of excess costs in health care into six domains: unnecessary services (volume), services delivered inefficiently, prices that are too high, excessive administrative costs, missed prevention opportunities, and fraud. Except for the last, the sessions organized by the Committee for the first workshop reviewed these domains in detail, and, while much work remains, the workshop presentations have offered a substantially enhanced understanding of the nature and size of the problems in each of those domains. Two things are clear: (1) each is an important contributor to excessive healthcare costs, and (2) the amount of excessive costs incurred from each is tremendous.

In discussions about potential cost control strategies and policy options, key levers for change were identified and considered in the second and third workshops, as vehicles for initiatives of particular policy relevance, including payment transformation, governance streamlining, transparency, knowledge development, care system redesign, and community health capacity. The nature, barriers, and potential impact of the various measures were extensively explored. At the request of the Planning Committee, a fourth workshop was scheduled to focus solely on the Series’ motivating proposition: reducing healthcare costs by 10 percent within 10 years, without compromising health outcomes or valued innovation.

Throughout the progression of the meetings, a number of opportunities and challenges were also identified around which the engagement of stakeholders such as those represented on the Roundtable, might be especially important and facilitative. These issues will be explored through future workshops, commissioned papers, collaborative activities, and public communication efforts.

We are especially indebted to the members of the Planning Committee, which crafted this unusually productive and path-breaking discussion series. The members of this stellar group were: Arnold Milstein (Pacific Business Group on Health, Committee Chair), Kathleen Buto (Johnson & Johnson), Robert S. Galvin (Global Healthcare/General Electric), Paul B. Ginsburg (Center for Studying Health System Change), Eric Jensen (McKinsey Global Institute), James Mathews (Medicare Payment Advisory Commission), Nancy H. Nielsen (American Medical Association), Steven D. Pearson (Institute for Clinical and Economic Review), Gail Shearer (Consumers Union), and Reed V. Tuckson (UnitedHealth Group).

Multiple other individuals and organizations donated their valuable time toward the development of this publication. We naturally also ac-

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knowledge and offer strong appreciation for the contributors to this volume, for the care and thought that went into their analyses and presentations, for the ideas and observations they shared at the workshops, and for their contributions to this summary publication. In this respect, we should underscore that this volume contains a collection of individually authored papers and intends to convey only the views and beliefs of those participating in the workshops, not the express opinions of the Roundtable on Value & Science-Driven Health Care, its members, its sponsors, or the Institute of Medicine.

A number of Roundtable staff played instrumental roles in coordinating the workshops and translating the workshop proceedings into this summary, including Pierre L. Yong (the staff officer with primary responsibility), Catherine Zweig, LeighAnne Olsen, Kate Vasconi, Jane Fredell, China Dickerson, Chanda Ijames, Patrick Burke, Christie Bell, and Ruth Strommen. Franklin A. Cruz also contributed substantially to publication development. We would also like to thank Vilija Teel, Jordan Wyndelts, Michele de la Menardiere, and Jackie Turner for helping to coordinate the various aspects of review, production, and publication.

Clearly, successfully addressing the challenges of lowering healthcare expenditures while preserving outcomes and innovation will require significant effort and collaboration. We believe the dialogue emerging from The Healthcare Imperative begins to define the opportunities and options for successfully tackling this challenge, and look forward to continued learning from its insights.

Denis A. Cortese

Chair, Roundtable on Value & Science-Driven Health Care


J. Michael McGinnis

Executive Director, Roundtable on Value & Science-Driven Health Care


Arnold Milstein

Planning Committee Chair

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Suggested Citation:"Front Matter." Institute of Medicine. 2010. The Healthcare Imperative: Lowering Costs and Improving Outcomes: Workshop Series Summary. Washington, DC: The National Academies Press. doi: 10.17226/12750.
×

Contents

Suggested Citation:"Front Matter." Institute of Medicine. 2010. The Healthcare Imperative: Lowering Costs and Improving Outcomes: Workshop Series Summary. Washington, DC: The National Academies Press. doi: 10.17226/12750.
×
   

 Costs from Physician Office Inefficiencies,
William F. Jessee

 

125

   

 Low-Cost Hospitals with High-Quality Scores,
Arnold Milstein

 

129

   

 Costs of Uncoordinated Care,
Mary Kay Owens

 

131

4

 

EXCESS ADMINISTRATIVE COSTS

 

141

   

 Excess Billing and Insurance-Related Administrative Costs,
James G. Kahn

 

142

   

 What Does It Cost Physician Practices to Interact with Payers?,
Lawrence P. Casalino, Sean Nicholson, David N. Gans, Terry Hammons, Dante Morra, and Wendy Levinson

 

151

   

 Cost Savings from Simplifying the Billing Process,
James L. Heffernan, Bonnie B. Blanchfield, Brad Osgood, Rosemary Sheehan, and Gregg S. Meyer

 

159

   

 Excess Health Insurance Administrative Expenses,
Andrew L. Naugle

 

166

5

 

PRICES THAT ARE TOO HIGH

 

175

   

 Price Implications of Hospital Consolidation,
Cory S. Capps

 

177

   

 Prescription Drug Prices,
Jack Hoadley

 

187

   

 Durable Medical Equipment Prices,
Thomas J. Hoerger

 

197

   

 Market Pricing and the Medicare Program,
Mark E. Wynn

 

202

   

 Medical Device Prices,
Jeffrey C. Lerner

 

209

6

 

MISSED PREVENTION OPPORTUNITIES

 

219

   

 The Price Paid for Not Preventing Diseases,
Steven H. Woolf

 

220

   

 Cost Savings from Primary and Secondary Prevention,
Thomas J. Flottemesch, Michael V. Maciosek, Nichol M. Edwards, Leif I. Solberg, and Ashley B. Coffield

 

225

   

 Tertiary Prevention and Treatment Costs,
Michael P. Pignone

 

232

Suggested Citation:"Front Matter." Institute of Medicine. 2010. The Healthcare Imperative: Lowering Costs and Improving Outcomes: Workshop Series Summary. Washington, DC: The National Academies Press. doi: 10.17226/12750.
×

SECTION II:
STRATEGIES THAT WORK

 

 

7

 

STRATEGIES THAT WORK

 

241

   

 Strategies That Work and How to Get There,
Glenn Steele, Jr.

 

245

   

 International Success at Cost Containment,
Gerard F. Anderson

 

251

8

 

KNOWLEDGE ENHANCEMENT

 

257

   

 Successes with Cost and Quality,
Lucy A. Savitz

 

259

   

 The Value of Electronic Health Records with Decision Support,
Rainu Kaushal and Lisa M. Kern

 

265

   

 Comparative Effectiveness Research,
Carolyn M. Clancy

 

270

   

 Enhancing Clinical Data as a Knowledge Utility,
Peter K. Smith

 

273

9

 

CARE CULTURE AND SYSTEM REDESIGN

 

281

   

 Community-Engaged Models of Team Care,
Michelle J. Lyn, Mina Silberberg, and J. Lloyd Michener

 

283

   

 Using Production System Methods in Medical Practice:
Kim R. Pittenger

 

287

   

 Managing Variability in Healthcare Delivery,
Eugene Litvak, Sandeep Green Vaswani, Michael C. Long, and Brad Prenney

 

294

   

 Cost Savings from Managing High-Risk Patients,
Timothy G. Ferris, Eric Weil, Gregg S. Meyer, Mary Neagle, James L. Heffernan, and David F. Torchiana

 

301

   

 Health Information Exchange and Care Efficiency,
Ashish Jha

 

310

   

 Antitrust Policy in Health Care,
Roger Feldman

 

314

   

 Reducing Service Capacity: Evidence and Policy Options,
Frank A. Sloan

 

319

   

 Malpractice Reform and Healthcare Costs,
Randall R. Bovbjerg

 

324

10

 

TRANSPARENCY OF COST AND PERFORMANCE

 

335

   

 Transparency in the Cost of Care,
John Santa

 

337

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 Transparency in Comparative Value of Treatment Options,
G. Scott Gazelle

 

340

   

 Provider Price and Quality Transparency,
Paul B. Ginsburg

 

344

   

 Transparency to Improve the Value of Hospital Care,
Peter K. Lindenauer

 

347

   

 Health Plan Transparency,
Margaret E. O’Kane

 

352

11

 

PAYMENT AND PAYER-BASED STRATEGIES

 

359

   

 Value-Based Payments, Outcomes, and Costs,
Harold D. Miller

 

361

   

 Bundled and Fee-for-Episode Payments: An Example,
Francois de Brantes, Amita Rastogi, Alice Gosfield, Doug Emery, and Edison Machado

 

370

   

 Effective Health Insurance Exchanges: An Example,
David R. Riemer

 

376

   

 Value-Based Insurance Designs and Healthcare Spending,
Niteesh K. Choudhry

 

380

   

 Tiered-Provider Networks and Value,
Lisa Carrara

 

386

   

 Simplifying Administrative Complexity,
Robin J. Thomashauer

 

390

   

 Technology and Simplifying Healthcare Administration,
David S. Wichmann

 

397

12

 

COMMUNITY-BASED AND TRANSITIONAL CARE

 

407

   

 Community Health Teams: Outcomes and Costs,
Kenneth E. Thorpe and Lydia L. Ogden

 

408

   

 Palliative Care, Quality and Costs,
Diane E. Meier, Jessica Dietrich, R. Sean Morrison, and Lynn Spragens

 

415

   

 Community Prevention and Healthcare Costs,
Jeffrey Levi

 

420

13

 

ENTREPRENEURIAL STRATEGIES

 

433

   

 Decentralizing Healthcare Delivery,
Jason Hwang

 

435

   

 Retail Clinics and Healthcare Costs,
N. Marcus Thygeson

 

438

   

 Care Coordination and Home Telehealth (CCHT),
Adam Darkins

 

443

Page xxiii Cite
Suggested Citation:"Front Matter." Institute of Medicine. 2010. The Healthcare Imperative: Lowering Costs and Improving Outcomes: Workshop Series Summary. Washington, DC: The National Academies Press. doi: 10.17226/12750.
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SECTION III:
THE POLICY AGENDA

 

 

14

 

THE POLICY AGENDA

 

455

   

 Getting to High-Performance,
Karen Davis

 

456

   

 CBO Scoring: Methods and Implications,
Joseph R. Antos

 

465

15

 

PAYMENTS FOR VALUE OVER VOLUME

 

473

   

 Bundled Payments: A Private Payer Perspective,
John M. Bertko

 

474

   

 Medicare and Bundled Payments,
Armen H. Thoumaian, Linda M. Magno, and Cynthia K. Mason

 

478

   

 Bundled Payment: Physician Engagement Issues,
George J. Isham

 

482

   

 Patient Perspective and Payment Reform,
Nancy Davenport-Ennis

 

489

16

 

MEDICALLY COMPLEX PATIENTS

 

493

   

 Payment Policies and Medically Complex Patients,
Arnold Milstein

 

495

   

 Palliative Care, Access, Quality, and Costs,
R. Sean Morrison, Diane E. Meier, and Melissa Carlson

 

498

   

 Payment and Better Care of Complex Patients,
Ronald A. Paulus, Jonathan Darer, and Walter F. Stewart

 

504

   

 Care of Patients with Multiple Chronic Conditions,
Anand K. Parekh

 

509

17

 

DELIVERY SYSTEM INTEGRATION

 

517

   

 Profile of System Fragmentation,
John Toussaint

 

519

   

 Payments to Promote Delivery System Integration,
Mark E. Miller

 

520

   

 Payment Reform to Promote Integration and Value,
Harold S. Luft

 

525

   

 Health Information Technology to Promote Integration,
Andrew M. Wiesenthal

 

529

18

 

DELIVERY SYSTEM EFFICIENCY

 

535

   

 Better Use of Healthcare Professionals,
Mary D. Naylor

 

536

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The United States has the highest per capita spending on health care of any industrialized nation but continually lags behind other nations in health care outcomes including life expectancy and infant mortality. National health expenditures are projected to exceed $2.5 trillion in 2009. Given healthcare's direct impact on the economy, there is a critical need to control health care spending.

According to The Health Imperative: Lowering Costs and Improving Outcomes, the costs of health care have strained the federal budget, and negatively affected state governments, the private sector and individuals. Healthcare expenditures have restricted the ability of state and local governments to fund other priorities and have contributed to slowing growth in wages and jobs in the private sector. Moreover, the number of uninsured has risen from 45.7 million in 2007 to 46.3 million in 2008.

The Health Imperative: Lowering Costs and Improving Outcomes identifies a number of factors driving expenditure growth including scientific uncertainty, perverse economic and practice incentives, system fragmentation, lack of patient involvement, and under-investment in population health. Experts discussed key levers for catalyzing transformation of the delivery system. A few included streamlined health insurance regulation, administrative simplification and clarification and quality and consistency in treatment.

The book is an excellent guide for policymakers at all levels of government, as well as private sector healthcare workers.

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