A new report released by the Institute of Medicine (IOM) on September 6, 2012, Best Care at Lower Cost: The Path to Continuously Learning Health Care in America, cites multiple inefficiencies and shortcomings in the healthcare industry that result in “missed opportunities, waste, and harm to patients.”  According to the IOM Report, America’s healthcare system is not evolving quickly enough: “The system needs to learn more rapidly, digest what does and does not work, and spread that knowledge in ways that can be broadly adapted and adopted.”  The 18-member IOM Committee estimates that about 30 percent of health spending in 2009, roughly $750 billion, was wasted on unnecessary services, excessive administrative costs, fraud, and other problems.  Another estimate suggests that 75,000 deaths could have been prevented in 2005 if every state had delivered services at the same level as the best-performing state.  In its report, IOM offers a roadmap for addressing these shortcomings.

IOM’s “roadmap” for transforming the nation’s healthcare system centers around the three-part goal of (1) building an adaptive system; (2) delivering reliable clinical knowledge to patients; and (3) improving the policy environment.  Specific recommendations for healthcare delivery organizations include:

• Digital Infrastructure.  Fully and effectively employ digital sys­tems that capture patient care experiences reliably and consistently, and implement standards and practices that advance the interoperability of data systems;
• Clinical Decision Support.  Accelerate integration of the best clinical knowledge into care decisions by adopting tools that deliver reliable, current clinical knowledge to the point of care and adopting incentives that encourage the use of these tools;
• Patient-Centered Care.  Monitor and assess patient perspectives and use the insights to improve care pro­cesses; establish patient portals to facilitate data sharing and communication among clinicians, patients, and families; and make high-quality, reliable tools available for shared decision making with patients at different levels of health literacy;
• Community Links.  Partner with community-based organi­zations and public health agencies to leverage and coordinate prevention, health promotion, and community-based interventions to improve health outcomes, including strategies related to the assessment and use of web-based tools;
• Care Continuity.  Develop care coordination and transition processes, data sharing capabilities, and communication tools to ensure safe, seam­less patient care; payers should promote effec­tive care transitions that improve patient health through their payment and contracting policies;
• Optimized Operations.  Continuously improve health care operations by utilizing systems engineering tools and process improve­ment methods to eliminate inefficiencies, remove unnecessary burdens on clinicians and staff, enhance patient experience, and improve patient health outcomes;
• Financial Incentives.  Reward continuous learning and improvement in the provision of best care at lower cost through internal practice incentives; payers should reward continu­ous learning and improvement through outcome- and value-oriented payment models, contracting policies, and benefit designs;
• Performance Transparency.  Increase transparency on health care system performance by collecting and expanding the availability of information on the safety, quality, prices and cost, and health outcomes of care to help inform care decisions and guide improvement efforts; and
• Broad Leadership.  Expand commitment to the goals of a continuously learn­ing health care system by developing organizational cultures that support and encour­age continuous improvement, the use of best practices, transparency, open communication, staff empowerment, coordination, teamwork, and mutual respect and align rewards accordingly.

The IOM Report is available on the IOM website, which can be accessed by clicking here.  The Report Brief is available by clicking here.  A summary of the IOM’s Recommendations is available by clicking here.

Reporter, Susan Banks, Washington, D.C., +1 202 626 2953, sbanks@kslaw.com.