From time to time AcademyHealth invites thought leaders to share their perspective on new publications and developments affecting the field of health services research and/or related to our mission of generating new evidence and moving that evidence into policy and practice. In the post below, Mark McClellan, M.D., Ph.D., senior fellow and director of the Health Care Innovation and Value Initiative at the Brookings Institution, reflects on the recent IOM report "Best Care at Lower Cost: The Path to Continuously Learning Health Care in America."

The health system is undergoing a period of rapid change, the newest recent developments being the launch of state and national exchanges for purchasing health insurance. Yet the changes in play span far beyond health insurance coverage—hospitals are adapting to the new payment models by Medicare and private payers, many care delivery systems are transitioning to Accountable Care Organizations or other integrated care models, researchers are working with PCORI, NIH, AHRQ, and others to develop evidence targeted to answer critical patient questions, and clinicians and patients are increasingly partnering together to make decisions centered on patient needs and goals.

The significant level of activity is due to an increasing recognition that the health system must produce better health at lower cost. And health service researchers play a vital role in making the required improvements happen. Working with AcademyHealth, we have many opportunities to collaborate, share lessons learned, and contribute to the improvements being made to the health care system.

A critical reference point for us in the health services research community is the recent IOM report, Best Care at Lower Cost: The Path to Continuously Learning Health Care in America, which presents a vision for a continuously learning and improving health system. Several characteristics have significant implications for our work:

  • A learning health system relies on real-time access to knowledge. This will require the research community to partner with clinicians, patients, payers, and the federal government to ensure that the clinical data generated during the course of care delivery is captured and used for generating new knowledge about what works—from ways to organize care delivery to payment models to strategies for integrating IT.
  • Payment structures to reward continuous learning and care improvement will be a critical component of a learning health system. We can partner with public and private payers to develop payment models, contracting policies, and benefits designs that reward care that delivers the best outcomes. This change will prompt the shift away from incentives for high volume and inefficiency to a system that rewards value and improving people’s health.
  • Health services researchers can also develop key metrics that will help stakeholders across the system assess health outcomes—at the individual and population level—and help guide their improvement efforts.

Summarizing the magnitude of the problem, Best Care at Lower Cost reports that some 75,000 lives could have been saved if all states had provided the quality of care delivered by the highest-performing state, and that almost one-third of the nation’s health spending did not improve people’s health. In this era of health reform, many stakeholders are already taking important measures to improve care, lower costs, and address the complexity of our system. Health researchers have much to contribute in this ever-changing environment.


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