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Institute of Medicine (US) Roundtable on Evidence-Based Medicine; Yong PL, Saunders RS, Olsen LA, editors. The Healthcare Imperative: Lowering Costs and Improving Outcomes: Workshop Series Summary. Washington (DC): National Academies Press (US); 2010.

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The Healthcare Imperative: Lowering Costs and Improving Outcomes: Workshop Series Summary.

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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, 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 acknowledge 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

Copyright © 2010, National Academy of Sciences.
Bookshelf ID: NBK53939

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