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Performance Improvement in Health Care—Seizing the Moment

The Issue

The federal government has a unique opportunity to use recent health reform legislation, including the Affordable Care Act, the American Recovery and Reinvestment Act, and the Health Information Technology for Economic and Clinical Health Act, to make extensive improvements to health care delivery in the United States. However, policymakers must resist the economic pressures for quick fixes and budget cuts and instead propose a comprehensive plan for health system improvement.

What the Study Found

Author David Blumenthal, Samuel O. Thier Professor of Medicine at Harvard Medical School and chair of The Commonwealth Fund Commission on a High Performance Health System, suggests that the federal government should first aim, by 2016, to hold the rate of increase in national health spending per capita to the annual projected growth in gross domestic product per capita plus 0.5 percentage points, and to maintain this rate through 2021. Achieving this target, Blumenthal says, would reduce spending by $893 billion over 10 years.

The government should focus on improving care for high-cost patients with multiple chronic conditions—a population that accounts for a disproportionate share of health care costs. The Commission proposes that the federal government, along with other stakeholders, create “Health Improvement Communities” across the country, where providers, payers, and other local stakeholders work collaboratively to redesign payment policy, enhance primary care access and health information technology, and create accountable care arrangements. This type of program, Blumenthal says, could save $184 billion, or 21 percent of the $893 billion overall savings target .


The U.S. has the tools to realize fundamental health care reform, but the federal government, along with private and public partners, must implement a coordinated plan that addresses "the root causes of our health care crisis." Establishing Health Improvement Communities could provide such a plan, Blumenthal concludes.

Publication Details



D. Blumenthal, "Performance Improvement in Health Care—Seizing the Moment," New England Journal of Medicine, April 26, 2012 366(17)1203–427.