K. Davis, Closing the Quality Chasm: Opportunities and Strategies for Moving Toward a High Performance Health System, Invited Testimony, Senate Committee on Health, Education, Labor, and Pensions, Hearing on "Crossing the Quality Chasm in Health Care Reform," January 29, 2009.
As the nation turns to the issue of reforming our health insurance system, it is important to address simultaneously how we organize and deliver health services—to ensure that we are obtaining the best possible health outcomes for Americans and the most value for the money we spend on health care. Unfortunately, the care we receive falls short of the care it is possible to deliver, and the gap is not narrowing. According to the most recent National Scorecard published by the Commonwealth Fund Commission on a High Performance Health System, the U.S. health system in 2008 scored 65 out of 100 possible points on 37 indicators of performance capturing key dimensions of health outcomes, quality, access, equity, and efficiency.
The scorecard shows that the U.S. is not making consistent progress in reducing the variability of health care quality and is failing to keep pace with gains in health outcomes achieved by our industrialized peers:
We are fortunate, however, that even within our imperfect system, models exist for each of the components that—if properly organized, reformed, and financed—can enable the nation to provide high-quality, affordable care to every American. The following examples of excellence from across the U.S. and around the world offer insight into what it takes to achieve high performance:
The specific policies that will both lead to better health outcomes and "bend the curve" of our nation's unsustainable health care spending revolve around five strategies that are amenable to action at the federal level:
Congress can continue to develop the infrastructure for improving quality by making investments in health information technology and information exchange networks. If the U.S. is serious about closing the quality chasm, it will also need a strong primary care system, which requires fundamentally reforming provider payment, encouraging all patients to enroll in a patient-centered medical home, and supporting physician practices that serve as medical homes with information technology and technical assistance for redesigning care processes. Funding for research on comparative effectiveness and establishing a center for comparative effectiveness are also crucial to value-based purchasing and performance-improvement initiatives. Finally, the federal government can raise the bar for health system performance by setting explicit goals and priorities for improvement—particularly with regard to the most prevalent chronic conditions, which account for a large majority of health care costs.
By applying these policies collectively, the nation would be able to capture the synergistic benefits of specific changes that, if implemented individually, would yield more modest improvements in quality and smaller reductions in projected spending. And, to be sure, any reforms must support health care providers in their efforts to deliver the best care possible for their patients.
Armed with the knowledge that the status quo is no longer acceptable, we have entered a new era ripe with opportunity to close the quality chasm and improve the health and well-being of American families. Working together, we can change course and put the U.S. health system on a path to high performance.