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Failure to insure all Americans>"  " $ $%Twelve Steps to Health Care Recovery&&(*Find Middle Ground Politically From the right: recognize the imperative to provide universal coverage From the left: recognize individual responsibility for health choices and income-based payment at all ages From both sides: break the uninsured population into component pieces and solve each part:"  "  %Twelve Steps to Health Care Recovery&&(Invest in Health Protection Pay for preventive services Strengthen public health infrastructure Put authority and responsibility in the same hands (avoid vaccine shortage) Support community-based prevention programs Eat smart, Keep moving, Stop smoking!:" " %Twelve Steps to Health Care Recovery&&(Put People First Patients needs and interests Physicians ability to serve as caring professionals End to unequal treatment:" l" l%Twelve Steps to Health Care Recovery&&(Fund and Deploy Information Technology  Hill-Burton for the Information Age Interest-free loans Loan guarantees  Utility fee set-aside on every health care dollar Electronic health record National performance and functional standards National certificationp(" &" X ^" (&X^%Twelve Steps to Health Care Recovery&&(Educate for quality and teamwork Graduate and post-graduate training for physicians, nurses, pharmacists, and other health professionals Systems perspective (processes, relationships, interactions, etc.) Compassion and technical excellence: patient-centered care:!" " !%Twelve Steps to Health Care Recovery&&(Rely on Evidence Use evidence-based guidelines as the presumptive clinical strategy, with individualized decision-making Systematically integrate clinical knowledge and expertise with patient values and preferences Mindless variation is the enemy of quality:" " %Twelve Steps to Health Care Recovery&&(Use Resources Intelligently Gain efficiencies by reducing variation, by smarter scheduling, and by administrative simplification Use bulk purchasing to obtain lower prices Ration more sensibly and fairly Define the basket of services in the universal care package:" " %Twelve Steps to Health Care Recovery&&(Insist on Transparency Support mandatory data reporting and public dissemination Refine adjustment standards over time to make data increasingly reliable and comparable:" " %Twelve Steps to Health Care Recovery&&(oExperiment with Care Models for Chronic Diseases Home-based Patient-centered Communication-reliant Team-managed:1" ?" 1?%Twelve Steps to Health Care Recovery&&(Pay for Performance Extend and learn from current experiments in public and private sectors to enhance reimbursement for higher quality care Enable competition based on outcomes:" " %Twelve Steps to Health Care Recovery&&(Reform the Malpractice System Alternatives to tort Workmen s compensation model Administrative adjudication or arbitration Prompt, fair compensation for avoidable injury Sanctions for negligent failure to meet professional standardsp" " H n" Hn%Twelve Steps to Health Care Recovery&&(;Assure Future Progress Fund and foster scientific discovery Large-scale, multi-disciplinary science Support of young investigators Clinical and health systems research for high-value interventions Evaluate effectiveness in practice and over time, not only efficacy (in selected populations) and pre-market approval p" %" G " %G:Health Care 2010 VisionPopulation and Ecological Perspective [community as well as individual] Prevention and Public Health [more than medical care alone] Universal, Accessible, and Affordable [not piecemeal coverage or unequal] Person-centered [not institution-centered] Scientific, Innovative, and Evidence-based [not anecdotal] Entrepreneurial and Well-managed [not ineptly administered] Quality- and Value-driven [not price-driven]PKey Idea A high-performance health system is within reach if we can overcome barriers to change and pursue a comprehensive strategy for improvement"!Are We Doing Enough?  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