IOM Report: Best Care at Lower Cost

Multipronged Solutions Necessary to Fix Ailing U.S. Health Care System

September 12, 2012 04:25 pm Sheri Porter

The Institute of Medicine (IOM) recently released a report that not only coined a new phrase -- "continuously learning health care system" -- to describe its vision of where the United States needs to take its current system, it called on Americans to set to work immediately to bring about an improved health care system.

The report, titled Best Care at Lower Cost: The Path to Continuously Learning Health Care in America(www.iom.edu), is intended to pave the way toward improving a health care system that, according to a Sept. 6 IOM press release(www8.nationalacademies.org) has become "too complex and costly to continue business as usual."

The Academy gave the report a thumbs-up.

"We agree with the majority of the report's recommendations," said AAFP President Glen Stream, M.D., M.B.I., of Spokane, Wash. "The report is consistent with what we've been saying for a long time and lends the very credible voice of the Institute of Medicine to the Academy's efforts to promote the patient-centered medical home (PCMH)."

story highlights

  • A new report released by the Institute of Medicine says the U.S. health care system is underperforming and wasting health care dollars.
  • Report authors call on stakeholders to begin a process of developing a "continuously learning health care system" that will produce the best patient care at a lower cost.
  • Many of the report's recommendations are consistent with the AAFP's efforts to promote the patient-centered medical home model of care.

Stream told AAFP News Now that many of the action items called for in the IOM report --including better adherence to evidence-based guidelines, a reduction in unnecessary medical care and the need for robust patient engagement -- are elements of the PCMH model of care.

Report Specifics

Mark Smith, president and CEO of the California HealthCare Foundation and chair of the committee that wrote the report, said in the IOM press release, "Our health care system lags in its ability to adapt, affordably meet patients' needs and consistently achieve better outcomes." However, the nation has the "know-how and technology" to make substantial improvements in the quality of health care patients receive and the money spent to deliver that care, Smith added.

According to the report, in 2009 alone, about $750 billion in health care dollars was wasted on unnecessary services, administrative costs and fraud. Report authors suggest that as many as 75,000 deaths could have been averted in 2005 if every state had delivered care at the quality level of the best performing state.

The report focused on a list of action items that touch many facets of health care. Authors urged health care stakeholders, including government agencies, to

  • manage the rapidly increasing complexity of the digital infrastructure and improve the capacity to capture data on the clinical aspects of patient care and the health care delivery process, as well as financial data;
  • clarify and improve regulations governing the collection and use of clinical data to ensure patient privacy and facilitate the seamless use of clinical data for care coordination and improved care delivery;
  • accelerate the integration of decision support tools to ensure that decisions made by clinicians and patients are supported by the best current evidence;
  • involve patients and families in decisions regarding their health and health care;
  • promote community and clinical partnerships, as well as services aimed at improving individual and population health;
  • improve coordination and communication within and across organizations, and reward health care professionals who perform these tasks effectively;
  • optimize health care operations to trim waste, streamline health care delivery and promote activities that improve patient health;
  • structure payment to reward continuous learning and the provision of quality care at a lower cost;
  • increase performance transparency and availability of information on the quality, cost and outcomes of care; and
  • commit to continuous learning and improvement as a priority for everyone involved in health care, including patients, families and clinicians.

Each of the ten recommendations is followed by specific strategies intended to help achieve progress toward the goals of the report.

Role of Family Physicians

In an interview with AAFP News Now, Rita Redberg, M.D., one of the report's authors and a cardiologist at the University of California-San Francisco Medical Center, called family physicians "essential stakeholders and implementers of the learning health care system that this report describes."

"We hope that they will find this report useful in their efforts to fully adopt health technology systems and to develop practices that are centered around patients and their family members," said Redberg.

"We want family physicians to be able to make full use of the wealth of health information that is now available so that they can more readily identify the most effective and efficient approaches to their patients' care," she added.

Redberg noted that she and her fellow IOM committee members intentionally didn't set priorities for achieving any one particular goal first "because we believe that each of the recommended actions is equally important and integral to one another."

And even though the committee refrained from setting a deadline by which all recommended work should be completed, Redberg said the digital infrastructure necessary to achieve the goals outlined in the report could be in place by the end of the decade.


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