"FOR DECADES, OBSERVERS OF THE U.S. health care system have watched a struggle against seemingly intractable problems: incomplete and unequal access to care; perverse payment incentives that fail to reward good outcomes; fragmented, uncoordinated, and highly variable care that results in safety risks and waste; a disconnect between quality and price; rising costs; consumer dissatisfaction; and the absence of productivity and efficiency gains common in other industries. These problems have resulted in a loss of value within the health system and have generated various reform proposals, with most focusing on providing greater access to or controlling the costs of care. Although laudable, this focus ignores the fundamental problem: health care value (defined here as outcomes relative to input costs) simply must increase to achieve these diverse goals."
"Enhancing value requires both explicit delivery system reform strategies and the associated organizational capacity to execute change. Sustainable health care value is created only when care process steps are eliminated, automated, appropriately delegated to lower-cost but capable staff, or otherwise improved (that is, when there is innovation). Innovative care-process change occurs when (1) consumers are actively engaged in behavior that mitigates disease or improves purchasing; (2) safer and more effective drugs or devices are developed and adopted; (3) clinicians deliver more rapid, appropriate, and reliable care; (4) unnecessary tests and therapies are eliminated; or (5) supply-chain costs are systematically lowered. These changes are most sustainable within a care system that measures innovation returns, focuses on value creation, and is appropriately rewarded in the market. But how can this kind of innovation occur?"
Read more http://content.healthaffairs.org/content/27/5/1235.full