Best Care at Lower Cost: The Path to Continuously Learning Health Care in America
2013

Consensus

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America's health care system has become too complex and costly to continue business as usual. Best Care at Lower Cost explains that inefficiencies, an overwhelming amount of data, and other economic and quality barriers hinder progress in improving health and threaten the nation's economic stability and global competitiveness. According to this report, the knowledge and tools exist to put the health system on the right course to achieve continuous improvement and better quality care at a lower cost.

The costs of the system's current inefficiency underscore the urgent need for a systemwide transformation. About 30 percent of health spending in 2009—roughly $750 billion—was wasted on unnecessary services, excessive administrative costs, fraud, and other problems. Moreover, inefficiencies cause needless suffering. By one estimate, roughly 75,000 deaths might have been averted in 2005 if every state had delivered care at the quality level of the best performing state. This report states that the way health care providers currently train, practice, and learn new information cannot keep pace with the flood of research discoveries and technological advances.

About 75 million Americans have more than one chronic condition, requiring coordination among multiple specialists and therapies, which can increase the potential for miscommunication, misdiagnosis, potentially conflicting interventions, and dangerous drug interactions. Best Care at Lower Cost emphasizes that a better use of data is a critical element of a continuously improving health system, such as mobile technologies and electronic health records that offer significant potential to capture and share health data better. In order for this to occur, the National Coordinator for Health Information Technology, IT developers, and standard-setting organizations should ensure that these systems are robust and interoperable. Clinicians and care organizations should fully adopt these technologies, and patients should be encouraged to use tools, such as personal health information portals, to actively engage in their care.

This book is a call to action that will guide health care providers; administrators; caregivers; policy makers; health professionals; federal, state, and local government agencies; private and public health organizations; and educational institutions.

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Table: Characteristics of a Continuously Learning Health Care System
Report Brief (html)

Publication information

436 pages · 6 x 9 · hardcover
ISBN Ebook: 0-309-26074-4
DOI: https://doi.org/10.17226/13444

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Institute of Medicine. 2013. Best Care at Lower Cost: The Path to Continuously Learning Health Care in America. Washington, DC: The National Academies Press.

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Front Matter i-xx
Abstract 1-4
Summary 5-44
Part I: The Imperatives 45-46
1 Introduction and Overview 47-62
2 Imperative: Managing Rapidly Increasing Complexity 63-90
3 Imperative: Achieving Greater Value in Health Care 91-110
4 Imperative: Capturing Opportunities from Technology, Industry, and Policy 111-130
Part II: The Vision 131-132
5 A Continuously Learning Health Care System 133-146
Part III: The Path 147-148
6 Generating and Applying Knowledge in Real Time 149-188
7 Engaging Patients, Families, and Communities 189-226
8 Achieving and Rewarding High-Value Care 227-254
9 Creating a New Culture of Care 255-280
10 Actions for Continuous Learning, Best Care, and Lower Costs 281-312
Appendix A: Glossary 313-314
Appendix B: A CEO Checklist for High-Value Health Care 315-388
Appendix C: ACA Provisions with Implications for a Learning Health Care System 389-400
Appendix D: Biosketches of Committee Members and Staff 401-416

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Best Care at Lower Cost: The Path to Continuously Learning Health Care in America (2013)

Chapter: Part III: The Path

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Best Care at Lower Cost: The Path to Continuously Learning Health Care in America (2013)

Chapter: Part III: The Path