Consensus
Individuals and families across the United States face growing challenges in accessing timely, high-quality primary care, which is essential to overall health and well-being. The delivery of such care is becoming more complex, placing undue strain on primary care clinicians and exacerbating existing workforce shortages.
A National Academies committee recently examined the inputs and functions needed for interprofessional teams to successfully and sustainably deliver high-quality primary care. The committee concluded the nation must support the primary care workforce through appropriate and supportive payment; hold payers, states, and health systems accountable in ensuring that such payment reaches primary care practices; and sufficiently train an interprofessional workforce. This report offers nine specific recommendations for how federal agencies and other key players can better support the provision of high-quality, interprofessional, team-based primary care.
58 pages
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ISBN Paperback: 0-309-99564-7
ISBN Ebook: 0-309-99565-5
DOI:
https://doi.org/10.17226/29226
National Academies of Sciences, Engineering, and Medicine. 2025. Building a Workforce to Develop and Sustain Interprofessional Primary Care Teams. Washington, DC: The National Academies Press.
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Military families raising children with autism often face unique challenges in accessing consistent, high-quality care across frequent moves and deployments. Applied behavior analysis, or ABA, is widely recognized as an effective intervention for many autistic individuals, yet military families report barriers that delay or restrict their access to these services.
The report The Comprehensive Autism Care Demonstration: Solutions for Military Families examines how the Department of Defense's autism care demonstration program is serving families and whether ABA should be covered as a TRICARE Basic benefit. Drawing on a careful review of the scientific literature, the report finds that ABA meets the Department's own standards for reliable medical evidence and should be formally authorized as a TRICARE Basic benefit.
The report identifies key areas where current demonstration policies differ from clinical standards. These include restrictive rules around assessments, limited flexibility in treatment goals and settings, and administrative requirements that impose unnecessary burdens on both families and ABA providers.
336 pages
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paperback
ISBN Paperback: 0-309-99314-8
ISBN Ebook: 0-309-99315-6
DOI:
https://doi.org/10.17226/29139
National Academies of Sciences, Engineering, and Medicine. 2025. The Comprehensive Autism Care Demonstration: Solutions for Military Families. Washington, DC: The National Academies Press.
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Tobacco use and alcohol use place first and third, respectively, as leading modifiable risk factors for cancer cases and deaths in the US. Our National Cancer Policy Forum convened a public workshop in March 2025 to examine current evidence on the health outcomes of tobacco and alcohol use, including their synergistic effects. Participants explored the state of research on tobacco and alcohol as cancer risk factors and differences in outcomes across U.S. populations. Speakers discussed potential strategies, such as community engagement and public health messaging, to reduce tobacco and alcohol use to lower cancer risk and improve health outcomes for all. This Proceedings of a Workshop summarizes presentations and discussions from the workshop.
76 pages
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ISBN Paperback: 0-309-60011-1
ISBN Ebook: 0-309-59987-3
DOI:
https://doi.org/10.17226/29264
National Academies of Sciences, Engineering, and Medicine. 2025. Addressing the Impact of Tobacco and Alcohol Use on Cancer-Related Health Outcomes: Proceedings of a Workshop. Washington, DC: The National Academies Press.
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Rising rates of stress, anxiety, and depression highlight the need to understand how the brain builds resilience across life stages. The National Academies' Forum on Neuroscience and Nervous System Disorders, in collaboration with the Forum on Mental Health and Substance Use Disorders, hosted a workshop in March 2025 to explore the neurobiological mechanisms of stress; critical periods for resilience development; and strategies to apply these insights in clinical, public health, and community-based approaches. This Proceedings of a Workshop highlights presentations and discussions that occurred at the workshop.
114 pages
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ISBN Paperback: 0-309-59922-9
ISBN Ebook: 0-309-59920-2
DOI:
https://doi.org/10.17226/29243
National Academies of Sciences, Engineering, and Medicine. 2025. Applying Neurobiological Insights on Stress to Foster Resilience Across Life Stages: Proceedings of a Workshop. Washington, DC: The National Academies Press.
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In July 2025, the Centers for Medicare & Medicaid Services solicited public comments on proposed policy changes for Medicare payments under the Physician Fee Schedule - and other Medicare Part B components - set to take effect on or after January 1, 2026. The National Academies convened a committee of experts in relevant fields to respond to the changes and outline specific recommendations. The resulting report addresses topics such as valuation of primary care services, management and prevention of chronic disease, and health coaching and motivational interviewing.
46 pages
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ISBN Ebook: 0-309-59984-9
DOI:
https://doi.org/10.17226/29259
National Academies of Sciences, Engineering, and Medicine. 2025. Response to the Centers for Medicare & Medicaid Services CY 2026 Physician Fee Schedule and Other Changes to Part B Payment and Coverage Policies Proposed Rule. Washington, DC: The National Academies Press.
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This is the first of two reports requested by the Social Security Administration (SSA) to address best practices and community experiences in the management and treatment of sickle cell disease (SCD). SCD, a group of inherited blood disorders affecting approximately 100,000 people in the United States, is a chronic, life-long condition that affects every organ system in the body. The life of an individual with SCD is often complicated by frequent bouts of extreme pain and hospitalizations, fatigue, organ damage, and mental health conditions. The cumulative burden of SCD-related health effects can significantly affect quality of life, including the ability to regularly attend and participate fully in school and work.
In response to SSA's request, the National Academies of Sciences, Engineering, and Medicine convened an expert, ad hoc committee to review the latest published scientific research and generate findings and conclusions on a variety of topics related to SCD. This report is the first report in a two-report series, and presents the committee's findings and conclusions pertaining to SCD pain crises, pain management, and treatment settings relevant to SSA disability determinations.
144 pages
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ISBN Paperback: 0-309-99306-7
ISBN Ebook: 0-309-99307-5
DOI:
https://doi.org/10.17226/29137
National Academies of Sciences, Engineering, and Medicine. 2025. Sickle Cell Disease in Social Security Disability Evaluations: Pain and Treatment Settings. Washington, DC: The National Academies Press.
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The United States is a global leader in biomedical research, generating therapeutic breakthroughs that advance the health of the nation and the world. The public and private sectors contribute to this advancement by funding biomedical research and development. The current level of investment in pharmaceutical development in the United States, while substantial, does not always yield desired health outcomes or meet the needs of patients. Public and private funders face a myriad of challenges that affect their funding decisions and hinder the ability of the drug development system to prioritize disease burden and unmet need - often leaving critical gaps in available treatment options.
To better understand these gaps, Gates Ventures and the Peterson Center on Healthcare asked the National Academies to examine current challenges and offer strategies and recommendations for improvement. The resulting report emphasizes that current research prioritization does not systematically account for disease burden and unmet needs, and describes how a robust, timely, accessible data system is needed. It also explores the ways in which implementing recommended policy changes could deliver better health outcomes.
246 pages
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ISBN Paperback: 0-309-99382-2
ISBN Ebook: 0-309-99383-0
DOI:
https://doi.org/10.17226/29157
National Academies of Sciences, Engineering, and Medicine. 2025. Aligning Investments in Therapeutic Development with Therapeutic Need: Closing the Gap. Washington, DC: The National Academies Press.
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Workshop_in_brief
Structural and systemic barriers continue to limit access to high-quality mental health and substance use disorder (MHSUD) care, particularly in underserved communities. Understanding how health and human services influence care delivery is essential to improving outcomes.
In July 2025, the National Academies Forum on Mental Health and Substance Use Disorders hosted a public workshop to explore how infrastructure, policies, and structural determinants of health such as housing and food security impact the accessibility, quality, and coordination of MHSUD services. Participants discussed various ways to operationalize promising practices, as well as strategies for uplifting community voices and strengthening accountability across the health and social sectors. This Proceedings of a Workshop-In Brief summarizes the presentations and discussions from the two-day event.
16 pages
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ISBN Ebook: 0-309-59919-9
DOI:
https://doi.org/10.17226/29242
National Academies of Sciences, Engineering, and Medicine. 2025. Enhancing Care and Services for Mental Health and Substance Use Disorders: Proceedings of a Workshop—in Brief. Washington, DC: The National Academies Press.
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Family members and other caregivers are increasingly providing complex, long-term care for loved ones living with serious illnesses or disabilities. While caregiving can be deeply meaningful, it also can bring significant physical, emotional, and financial burdens. The National Academies convened a public workshop in June 2025 to examine strategies to reduce caregiver burden; practices to serve the unique needs of populations such as young and working caregivers; and opportunities to scale successful programs and advance supportive policies across health, social, and workplace settings. This Proceedings of a Workshop-in Brief provides a summary of the workshop presentations and discussions, including perspectives from family caregivers, health care providers, researchers, and policy leaders.
21 pages
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ISBN Ebook: 0-309-59964-4
DOI:
https://doi.org/10.17226/29237
National Academies of Sciences, Engineering, and Medicine. 2025. Strategies and Interventions to Strengthen Support for Family Caregivers for Individuals with Serious Illness or Disability: Proceedings of a Workshop—in Brief. Washington, DC: The National Academies Press.
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Understanding of the relationship between chronic pain and disability - particularly different lived experiences of chronic pain - is critical to developing effective management strategies and improving quality of life for those affected. The Social Security Administration, which administers programs to monetarily compensate and supplement the incomes of people with disabilities, funded a National Academies workshop in April 2025 to explore the functional effects and disability determination implications of chronic pain. This Proceedings of a Workshop highlights the presentations and discussions that occurred at the workshop.
122 pages
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ISBN Paperback: 0-309-99513-2
ISBN Ebook: 0-309-99514-0
DOI:
https://doi.org/10.17226/29181
National Academies of Sciences, Engineering, and Medicine. 2025. Exploring the Treatment and Management of Chronic Pain and Implications for Disability Determinations: Proceedings of a Workshop. Washington, DC: The National Academies Press.
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Visual field is the total area of space a person can see when the eyes are focused on a central point. Impairment of the visual field can have significant negative effects on well-being. Individuals with moderate to severe visual field loss may have difficulty performing routine tasks, such as reading, driving, and navigating environments, as well as engaging in social activities. More profound loss leads to greater disability and poorer quality of life. Nearly 8 million people in the U.S. indicate they have blindness or difficulty seeing even while wearing corrective lenses, and the prevalence of visual impairment among U.S. preschool-aged children may be as high as five percent.
Testing for visual field impairment involves a combination of hardware, stimuli, testing patterns, and algorithms. The Social Security Administration (SSA) uses the results of such testing to determine whether applicants for disability based on visual field loss qualify for benefits. In response to a request from SSA, the National Academies convened a committee of experts to review the research and science on methods for testing visual field impairment. The resulting report reviews current and emerging practices and known limitations in visual field testing and offers conclusions to inform disability evaluations.
160 pages
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ISBN Paperback: 0-309-99252-4
ISBN Ebook: 0-309-99253-2
DOI:
https://doi.org/10.17226/29124
National Academies of Sciences, Engineering, and Medicine. 2025. Visual Field Assessment and Disability Evaluation. Washington, DC: The National Academies Press.
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Diagnostic errors are a significant patient safety concern, impacting millions of people across the United States each year. Strengthening education and training for all health care professionals involved in the diagnostic process is essential to improving diagnostic accuracy, timeliness of treatment, and patient outcomes.
In April 2025, the National Academies Forum on Advancing Diagnostic Excellence hosted a public workshop to examine approaches to strengthening health care professional education and training in diagnosis. Speakers explored key topics such as improving diagnostic reasoning for trainees and educators, promoting the appropriate use of diagnostic tests and technologies, fostering patient-centered communication, and advancing interprofessional collaboration. This Proceedings of a Workshop-In Brief highlights the presentations and discussions that occurred at the workshop.
19 pages
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ISBN Ebook: 0-309-99468-3
DOI:
https://doi.org/10.17226/29203
National Academies of Sciences, Engineering, and Medicine. 2025. Advancing Health Care Professional Education and Training in Diagnostic Excellence: Proceedings of a Workshop—in Brief. Washington, DC: The National Academies Press.
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The development of minimally invasive approaches to screen for multiple tumor types at one time could potentially improve health outcomes; however, the clinical utility of multicancer detection (MCD) testing has yet to be established. The National Academies National Cancer Policy Forum held a workshop in October 2024 to explore the current scientific understanding and clinical use of MCD testing, as well as implications for cancer care and outcomes for all patients.
66 pages
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ISBN Paperback: 0-309-99243-5
ISBN Ebook: 0-309-99244-3
DOI:
https://doi.org/10.17226/29114
National Academies of Sciences, Engineering, and Medicine. 2025. Opportunities and Challenges for the Development and Adoption of Multicancer Detection Tests: Proceedings of a Workshop. Washington, DC: The National Academies Press.
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As people get older, they become more likely to have hearing difficulties in certain situations; for example, having conversations in public settings where there is naturally more noise. This can sometimes lead to isolation, depression, or even fatigue from the effort needed to communicate with others. Clinicians and researchers often do not use standardized outcome measures for hearing interventions that reflect patients' perceptions of real-life improvements.
The National Academies of Sciences, Engineering, and Medicine convened a committee of experts to identify a core set of outcomes and corresponding measures that researchers and clinicians should use each time they assess the effectiveness of hearing aids and other treatments in addressing hearing difficulties. The resulting report, Measuring Meaningful Outcomes for Adult Hearing Health Interventions, presents those outcomes and measures, as well as recommendations for promoting their use within the hearing health community.
266 pages
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ISBN Paperback: 0-309-99237-0
ISBN Ebook: 0-309-99238-9
DOI:
https://doi.org/10.17226/29104
National Academies of Sciences, Engineering, and Medicine. 2025. Measuring Meaningful Outcomes for Adult Hearing Health Interventions. Washington, DC: The National Academies Press.
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In 2024, the National Academies of Sciences, Engineering, and Medicine were tasked with convening a committee to examine the current process and data inputs used by the Centers for Medicare and Medicaid Services (CMS) to valuate primary care in the Physician Fee Schedule. Additionally, the committee was tasked with outlining alternative methodologies for data collection and potential sources of input to more accurately capture the time, intensity, and complexity of the work required to deliver high-quality primary care.
The resulting report, Improving Primary Care Valuation Decisions for the Physician Fee Schedule by the Center for Medicare, makes specific recommendations for CMS to address the systemic flaws currently affecting primary care professionals and limiting the potential of high-quality primary care services for all.
64 pages
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ISBN Paperback: 0-309-73535-1
ISBN Ebook: 0-309-73536-X
DOI:
https://doi.org/10.17226/29069
National Academies of Sciences, Engineering, and Medicine. 2025. Improving Primary Care Valuation Processes to Inform the Physician Fee Schedule. Washington, DC: The National Academies Press.
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When someone experiences the loss of a limb or severe facial disfigurement, one of their options may be vascularized composite allotransplantation (VCA), which transfers a graft containing multiple tissues transferred as a functional unit. Using VCA to restore the functionality and aesthetics of a lost upper limb or disfigured face is a profound and life-altering gift; however, the process and the decision to accept (or donate) a VCA graft is complex and deeply emotional. In addition to psychosocial considerations, a VCA recipient must commit to undergoing years of rigorous rehabilitation, have a robust support system in place, and accept and understand the risks of being on immunosuppressive drugs for the rest of their life. Despite VCA advances over the last 25 years, challenges remain, and the small number of recipients of face or hand transplants makes it difficult to generalize outcomes.
To address these challenges, the Department of Defense Reconstructive Transplant Research Program tasked a committee of the National Academies with developing principles and a framework for the standardization, assessment, and validation of protocols and standard operating procedures for face and hand transplantation. The resulting report offers guidance for the newly established Clinical Organization Network for Standardization of Reconstructive Transplantation (CONSORT), but it also includes specific recommendations to enable the larger VCA community to mature, advance, and thrive into the future.
388 pages
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ISBN Paperback: 0-309-73108-9
ISBN Ebook: 0-309-73109-7
DOI:
https://doi.org/10.17226/28580
National Academies of Sciences, Engineering, and Medicine. 2025. Advancing Face and Hand Transplantation: Principles and Framework for Developing Standardized Protocols. Washington, DC: The National Academies Press.
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Population-based cancer surveillance has a pivotal role in assessing the nation's progress in cancer control and helps inform research and care interventions aimed at reducing the burden of cancer on patients and communities, including the ability to identify health disparities in cancer outcomes. However, challenges with the current approach to cancer surveillance in the United States include delays and gaps in data collection, as well as inadequate infrastructure and workforce to keep pace with the informatics and treatment-related advances in cancer. To examine opportunities to enhance and modernize cancer surveillance in order to improve cancer research, care, and outcomes for all patients, the National Academies National Cancer Policy Forum hosted a public workshop in July 2024. This Proceedings of a Workshop highlights the presentations and discussions that occurred at the workshop.
94 pages
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ISBN Paperback: 0-309-73222-0
ISBN Ebook: 0-309-73223-9
DOI:
https://doi.org/10.17226/28676
National Academies of Sciences, Engineering, and Medicine. 2025. Enabling 21st Century Applications for Cancer Surveillance Through Enhanced Registries and Beyond: Proceedings of a Workshop. Washington, DC: The National Academies Press.
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Oral health is essential to overall health and well-being, but an epidemic of oral diseases - with regional dental professional shortages and a lack of dental insurance - is leaving many without sufficient dental care. In November 2024, the National Academies hosted a hybrid public workshop to discuss practices and models for improving oral health across the lifespan. Discussions covered main factors affecting oral health, including health policy, payment models and insurance coverage, community engagement, and workforce issues.
13 pages
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ISBN Ebook: 0-309-09932-3
DOI:
https://doi.org/10.17226/29096
National Academies of Sciences, Engineering, and Medicine. 2025. Advancing Oral Health Across the Lifespan: Proceedings of a Workshop—in Brief. Washington, DC: The National Academies Press.
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