US National Academy of Medicine makes a pitch for value-based healthcare


In the thick of the row over the repeal of Obamacare and what is to follow, the US National Academy of Medicine (NAM) has set out its prospectus for reform of the US healthcare system

‘Vital Directions for Health and Health Care’ builds on 19 white papers focussing on various aspects of the healthcare system that were commissioned by NAM.

These point to the extent of the problems, starting with the unsustainable cost – now standing at $3.2 trillion per year; wasteful spending of 30 per cent or more; persistent health disparities; failure of public health policy to address social and behavioural causes of ill health; and the financial burden on government, the private sector, and individuals

NAM sets out priorities for action, saying that to advance value-based care for all, policy reforms should do the following:

1. Drive health care payment innovation providing incentives for outcomes and value

Payment for individual services inherently encourages volume over outcomes. The reward focus adopted by all payers needs to target patient- and population-specific profiles that yield better outcomes at reasonable costs for care for a designated population over a specified period.

2. Help clinicians develop the core competencies required for new payment models

As new payment models are implemented and tested for their effects on care outcomes and value as well as patient and clinician satisfaction, clinician practices need to develop the adaptive core competencies to succeed.

3. Remove barriers to integration of social services with medical services

Treatments are frequently prescribed without consideration of the social, behavioural, and environmental factors that are important determinants of health. Integrated arrangement, financing, and delivery of non-medical social services, for example, food, housing, transportation, and income assistance, with medical services is important to improve outcomes, yield savings, and enhance equity.

4. Empower People

Consistently and effectively engaging patients and families is essential to improve health outcomes and efficient use of care. Yet care and care instructions are still too often poorly matched to the personal context of patients’ daily lives or their individual goals. Health care must not only be safe and effective, but also be understandable and practical, accounting for patient and family knowledge and circumstances and linking them with easy access to ongoing information and communication channels.

The paper is published here:



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