National Academy of Medicine releases publication on how to improve nation's health system

As the nation discusses repealing and replacing the Affordable Care Act, the National Academy of Medicine today released a publication on crosscutting priorities that provides a succinct blueprint to address challenges to Americans' health and health care that span beyond debates over insurance coverage. The paper is part of the NAM's Vital Directions for Health and Health Care Initiative, which conducted a comprehensive national health and health care assessment over the past 18 months. Written by the initiative's bipartisan steering committee, the publication presents a streamlined framework of eight policy directions consisting of four priority actions and four essential infrastructure needs to advance American health, health care, and scientific progress.

"As important as discussions related to the best ways to provide coverage are, Americans are facing challenges in health care that go beyond coverage provisions in the Affordable Care Act or the proposed American Health Care Act. For coverage to have value, our health care system has to work toward attaining its fullest potential," said Victor J. Dzau, president of the National Academy of Medicine and co-chair of the initiative steering committee. "In the midst of controversies and political debates, we can't afford to lose focus on the ultimate goal of achieving better health for all through an effective health care system—one that not only helps people prevent and treat their ailments but also helps every American reach their best health and well-being. With so many voices and ideas on how to reform health care, we wanted to cut through all the noise and draw upon expert advice for the most direct path the country should take."

For its initiative, NAM recruited more than 150 leading experts in health policy, science, and research to examine how to address ongoing, national challenges—such as high costs, disparities in health, and the burden of chronic illness and disability—and to propose the most promising opportunities to improve health and health care in the U.S. The publication summarizes concisely the most important information from the initiative's collection of 19 expert papers and a national symposium and builds upon lessons learned during previous health care reform experiences.

The experts agreed that achieving an optimal health and health care system for the United States requires commitment to three core goals: better health and well-being, high-value health care, and strong science and technology. To achieve these three goals, they identified eight policy directions for the nation that consist of four action priorities and four infrastructure needs. The complexity and magnitude of the issues calls for vigorous leadership from every quarter, beginning with federal initiatives, but ultimately anchored in strong leadership and capacity at the state and local levels.

The four action priorities are to ensure payments reward high-quality care that is affordable for all, empower people to be fully informed and engaged in their personal health decisions, activate communities to mobilize resources and promote partnerships for local solutions and health progress, and connect care by implementing integrated services and seamless digital interfaces for care. The four infrastructure needs are to use consistent and meaningful metrics to reduce reporting burdens and sharpen clinical performance and outcomes, modernize workforce skills for the 21st century health care and biomedical science, accelerate the use of real-world data by deriving evidence from everyday experience, and advance research to cures through innovation-ready clinical research processes, efficient regulation, and partnerships.

"These priorities offer major opportunities to improve health outcomes and prevent avoidable costs in the U.S. health care system," said Mark McClellan, co-chair of the initiative steering committee; professor and director of the Duke-Margolis Center for Health Policy, Duke University; and former director of the Center for Medicare and Medicaid Services from 2004 to 2006. "The policy directions represent a substantial departure from the status quo, and are needed now more than ever as health costs and health disparities continue to rise. They reflect strategies that have advanced from concepts to knowledge and tools that can be put to work to achieve better health in the U.S."

The paper underscores that evidence exists on the potential of the eight policy directions to deliver better health for all Americans at a sustainable cost. Moreover, recent bipartisan legislation in some of these policy areas—such as the 21st Century Cures Act for more efficient drug development and approval and the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) for payment reform—are strong indicators that these priorities will garner broad support.

"I believe the National Academy of Medicine's Vital Directions initiative is uniquely helpful to my former colleagues in Congress and to the new administration as they shape health policy priorities in coming months and years," said former U.S. Senator William H. Frist, a member of the initiative steering committee. "No other effort reflects such a rigorous, inclusive process to compile and prioritize the very best advice from experts and stakeholders across the country," added former U.S. Senator Thomas Daschle, also a steering committee member.

The purpose of the Vital Directions for Health and Health Care initiative is to compile expert information and guidance about important directions for health and health care in the United States. The views presented in this discussion paper series are those of the authors and do not represent formal consensus positions of the NAM; the National Academies of Sciences, Engineering, and Medicine; or the authors' organizations.

The National Academy of Medicine (NAM), established in 1970 as the Institute of Medicine, is an independent organization of eminent professionals from diverse fields including health and medicine; the natural, social, and behavioral sciences; and beyond. It serves alongside the National Academy of Sciences and the National Academy of Engineering as an adviser to the nation and the international community. Through its domestic and global initiatives, the NAM works to address critical issues in health, medicine, and related policy and inspire positive action across sectors. The NAM collaborates closely with its peer academies and other divisions within the National Academies of Sciences, Engineering, and Medicine.