the coming decade, long-term savings from better care and sustainable spending growthwill exceed $1 trillion over 20 years. While this framework focuses on lower costs throughsupporting reforms in health care delivery, it can be combined with other reforms toachieve additional reductions in health care costs.
The report recognizes that we live in a time of unprecedented breakthroughs in genomics,systems biology, and other biomedical sciences that are leading to better prevention andto innovative combinations of treatments based increasingly on each person’scharacteristics and preferences. Furthermore, improvements in wireless technologies andother non-medical technologies make it possible to prevent complications, and delivercare at home and in other settings different from traditional medical care. To takeadvantage of these opportunities to improve care, health care änancing must shift awayfrom paying on a fee- for- service basis for speciäc medical services, and toward paying forcoordinated care that meets each patient’s needs.Focusing on person-level quality of care as the fundamental strategy for addressing healthcare cost growth is in some ways new, but it builds on promising ideas and trendsthroughout our health care system. Our group is by no means the only ones who havereached this conclusion. A broad variety of recent reports, from the Simpson-BowlesCommission, the Bipartisan Policy Center, and others, all agree that the most importantthing that policymakers can do now to improve health care quality is to make feasiblechanges in health care payments and beneäts so that they can better support patient-centered care. Improving quality in health care is difäcult, it must be done carefully toavoid unintended consequences, and the quality and cost problems won’t be solvedovernight. But so long as providers are generally paid more for more services rather thanbetter quality, and so long as patients get more beneäts and more änancial support whenthey use more services rather than take steps toward better health and using care moreeffectively, our policies are not providing the needed support and momentum for solvingthese problems.The same principle applies to achieving better quality measures. Just as it is hard forpatients to understand prices when they have to add up dozens or hundreds of speciäcfees for speciäc services, it is hard to get a meaningful picture of the overall quality of careat the patient level from quality measures that have to accompany dozens of speciäcservices across different types of providers. While these speciäc aspects of care all matter,what really matters to most patients is how these speciäc services or aspects of care cometogether for their speciäc needs. For a knee replacement, putting all of these services andprocesses of care together, were they treated well, did they avoid any safety problems and
complications, and is their knee function improved? For patients at risk of complications