President's Message

	President's Message A Ten-Point Strategy to Achieve Better Health Care for All
	1.	Agree on Shared Values and Goals
	2.	Organize Care and Information Around the Patient
	3.	Expand the Use of Information Technology
	4.	Enhance the Quality and Value of Care
	5.	Reward Performance
	6.	Simplify and Standardize
	7.	Expand Health Insurance and Make Coverage Automatic
	8.	Guarantee Affordability
	9.	Share Responsibility for Health Care Financing
	10.	Encourage Collaboration
	Printable version of this article (20 pages)

As a nation, we have the capacity to shape a health care system that enhances our national competitiveness and quality of life by delivering the best care for all our citizens. Our aspirations should be nothing short of a health care system dedicated to ensuring safe, effective, patient-responsive, timely, efficient, and equitable care for all.⁽⁸⁾ Today, however, we tolerate a system that fails too many of our people, compromising the health of our workforce, straining our economy, and depriving too many Americans of a healthy and secure retirement.

To forge consensus on directions for change, we need to embark on a national discussion about our shared values and goals for health care. We have the talent and resources to achieve a high-performance health system, but first we must identify what we want as a society from our health care system and what we hope to achieve over time.

The process could begin with the creation of a set of performance goals and interim targets. Establishing goals and targets would certainly involve debates over spending. Whatever the outcome, we should begin to give as much emphasis to the possibility of achieving savings through administrative simplification and elimination of waste as we give to improving access and quality, increasing responsiveness to patients, and reducing medical errors. The national discussion on health care priorities should be framed, as well, by a clear vision of the practical challenges we face and the attributes of the current system we value most highly.

To get access to the health care system, each patient needs a "medical home," a personal clinician or primary care practice that delivers routine care and manages chronic conditions. People with ready access to primary care use emergency rooms less and know where to turn when they are in pain or worried about a medical problem. Continuity of care with the same physician over time has also been associated with better care, increased trust, and patient adherence to recommended care.

Ideally, a patient's medical home would maintain up-to-date information on all care received by the patient, including emergency room services, medications, lab tests, and preventive care. It would not necessarily serve as a "gatekeeper" to other services but would be responsible for coordinating care, ensuring preventive care, and helping patients navigate the system. Its clinicians would be expected to meet quality standards in key areas, such as ensuring that patients get access to the care they need, supporting them in making decisions about their own and their children's care, coordinating care among providers, collecting patient feedback through surveys and other means, and providing information on physicians and services that meet physician directory standards recommended by the National Committee for Quality Assurance.⁽⁹⁾

Implementing the medical-home approach to primary care would almost certainly require the development of a new payment system. The blended per-patient panel fee and fee-for-service system in use in Denmark is one potential model.⁽¹⁰⁾

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Percent of primary care physicians who:

* Computerized or manual reminder notices.
The Commonwealth Fund 2003 National Survey of Physicians and Quality of Care.