Vital Directions for Health and Health Care


Discussion Paper Series

  Vital DirectionsThrough the Vital Directions for Health and Health Care Initiative, the National Academy of Medicine called on more than 150 leading researchers, scientists, and policymakers from across the United States to provide expert guidance on 19 priority focus areas for U.S. health policy. The views presented in this discussion paper series are those of the authors and do not represent formal consensus positions of the NAM, the National Academies of Sciences, Engineering, and Medicine, or the authors’ organizations. Learn more: Inquiries: Elizabeth Finkelman ( Twitter: #NAMVitalDx


Papers in the Vital Directions series are organized around three overarching goals for the United States: better health and well-being; high-value health care; and strong science and technology. Browse the papers by subject below. 


Better Health and Well-Being


Systems Strategies for Better Health Throughout the Life Course

Authors: J. Michael McGinnis, National Academy of Medicine; Don Berwick, Institute for Healthcare Improvement; Tom Daschle, Former U.S. Senator, The Daschle Group; Angela Diaz, Mount Sinai; Harvey Fineberg, Gordon and Betty Moore Foundation; Bill Frist, Former U.S. Senator, Bipartisan Policy Center; Atul Gawande, Ariadne Labs, Brigham & Women’s Hospital, Harvard University; Neal Halfon, University of California, Los Angeles; and Risa J. Lavizzo-Mourey, Robert Wood Johnson Foundation


Addressing Social Determinants of Health and Health Disparities

Authors: Nancy E. Adler, University of California, San Francisco; David M. Cutler, Harvard University; Jonathan E. Fielding, University of California, Los Angeles; Sandro Galea, Boston University; M. Maria Glymour, University of California, San Francisco, Howard K. Koh, Harvard University; and David Satcher, Morehouse School of Medicine


Preparing for Better Health and Health Care for an Aging Population

Authors: Jack W. Rowe, Columbia University; Lisa Berkman, Harvard University; Linda Fried, Columbia University; Terry Fulmer, John A. Hartford Foundation; James Jackson, University of Michigan; Mary Naylor, University of Pennsylvania; William Novelli, Georgetown University; Jay Olshansky, University of Illinois at Chicago; and Robyn Stone, LeadingAge


Chronic Disease Prevention: Tobacco, Physical Activity, and Nutrition for a Healthy Start

Authors: William H. Dietz, George Washington University; Ross C. Brownson, Washington University; Clifford E. Douglas, American Cancer Society; John J. Dreyzenher, Tennessee Department of Health; Ron Z. Goetzel, Truven Health Analytics; Steven L. Gortmaker, Harvard T.H. Chan School of Public Health; James S. Marks, Robert Wood Johnson Foundation; Kathleen A. Merrigan, George Washington University; Russell R. Pate, University of South Carolina; Lisa M. Powell, University of Illinois at Chicago; and Mary Story, Duke University


Improving Access to Effective Care for People Who Have Mental Health and Substance Use Disorders

Authors: James Knickman, New York University; K. Ranga Rama Krishnan, Rush University Medical Center; Harold A. Pincus, College of Physicians and Surgeons, Columbia University and New York Presbyterian Hospital; Carlos Blanco, National Institutes of Health; Dan G. Blazer, Duke University Medical Center; Molly J. Coye, AVIA; John H. Krystal, Yale University School of Medicine; Scott L. Rauch, McLean Hospital; Gregory E. Simon, Group Health Research Institute; and Benedetto Vitiello, National Institutes of Health


Advancing the Health of Communities and Populations

Authors: Lynn Goldman, George Washington University; Georges Benjamin, American Public Health Association; Sandra Hernández, California Health Care Foundation; David Kindig, University of Wisconsin; Shiriki Kumanyika, University of Pennsylvania; Carmen Nevarez, Public Health Institute; Nirav R. Shah, Kaiser Permanente; and Winston Wong, Kaiser Permanente


High-Value Health Care


Benefit Design to Promote Effective, Efficient, and Affordable Care

Authors: Michael E. Chernew, Harvard Medical School; A. Mark Fendrick, University of Michigan; Sherry Glied, New York University; Karen Ignagni, EmblemHealth; Steve Parente, University of Minnesota; Jamie Robinson, University of California, Berkeley; and Gail Wilensky, Project HOPE


Payment Reform for Better Value and Medical Innovation

Authors: Mark McClellan, Duke University; David Feinberg, Geisinger Health System; Peter Bach, Memorial Sloan Kettering Cancer Center; Paul Chew, Sanofi; Patrick Conway, Centers for Medicare & Medicaid Services; Nick Leschly, Bluebird; Greg Marchand, Boeing; Michael Mussallem, Edwards Biosciences; Rick Pollack, American Hospital Association; and Dorothy Teeter, Washington Health Care Authority


Competencies and Tools to Shift Payments from Volume to Value

Authors: Michael O. Leavitt, Former Governor of Utah, Leavitt Partners; Susan D. DeVore, Premier, Inc.; Elliott Fisher, Dartmouth College; Rick Gilfillan, Trinity Health; H. Steve Lieber, Healthcare Information and Management Systems Society; Richard Merkin, Heritage Provider Network; Jeffrey Rideout, Integrated Healthcare Association; and Kent J. Thiry, DaVita Healthcare Partners, Inc.


Tailoring Complex Care Management, Coordination, and Integration for High-Need, High-Cost Patients

Authors: David Blumenthal, The Commonwealth Fund; Gerard Anderson, Johns Hopkins University; Sheila Burke, Harvard John. F. Kennedy School; Ashish K. Jha, Harvard T.H. Chan School of Public Health; Terry Fulmer, John A. Hartford Foundation; and Peter Long, Blue Shield of California Foundation


Realizing the Full Potential of Precision Medicine in Health and Health Care

Authors: Victor Dzau, National Academy of Medicine; Geoffrey S. Ginsburg, Duke University; Aneesh Chopra, Hunch Analytics; Dana Goldman, University of Southern California; Eric D. Green, National Institutes of Health; Debra G.B. Leonard, University of Vermont; Mark McClellan, Duke University; Andy Plump, Takeda Pharmaceuticals; Sharon F. Terry, Genetic Alliance; and Keith Yamamoto, University of California, San Francisco


Fostering Transparency in Outcomes, Quality, Safety, and Costs

Authors: Peter Pronovost, Johns Hopkins University; J. Matthew Austin, Johns Hopkins University; Christine K. Cassel, Kaiser Permanente School of Medicine; Suzanne F. Delbanco, Catalyst for Payment Reform; Ashish K. Jha, Harvard T.H. Chan School of Public Health; Bob Kocher, Venrock; Elizabeth A. McGlynn, Kaiser Permanente; Lewis G. Sandy, UnitedHealth Group; and John Santa, formerly Consumer Reports


The Democratization of Health Care

Authors: Paul C. Tang, IBM Watson Health; Mark D. Smith, University of California, San Francisco; Julia Adler-Milstein, University of Michigan; Tom Delbanco, Beth Israel Deaconess Medical Center; Stephen J. Downs, Robert Wood Johnson Foundation; Debra L. Ness, National Partnership for Women & Families; Ruth M. Parker, Emory University; and Danny Z. Sands, Conversa Health


Workforce for 21st Century Health and Health Care

Authors: Steven H. Lipstein, BJC HealthCare; Arthur L. Kellermann, Uniformed University of the Health Sciences; Bobbie Berkowitz, Columbia University; Robert Phillips, American Board of Family Medicine; Glenn D. Steele, Jr., xG Health Solutions; David Sklar, University of New Mexico; and George E. Thibault, Josiah Macy Jr. Foundation


Strong Science & Technology


Information Technology Interoperability and Use for Better Care and Evidence

Authors: Jonathan B. Perlin, Hospital Corporation of America; Dixie B. Baker, Martin Blanck, and Associates; David J. Brailer, Health Evolution Partners; Douglas E. Fridsma, American Medical Informatics Association; Mark E. Frisse, Vanderbilt University; John D. Halamka, Beth Israel Deaconess Medical Center; Jeffrey Levi, George Washington University; Kenneth D. Mandl, Boston Children’s Hospital and Harvard Medical School; Janet M. Marchibroda, Bipartisan Policy Center; Richard Platt, Harvard University; and Paul C. Tang, IBM Watson Health


Data Acquisition, Curation, and Use for a Continuously Learning Health System

Authors: Harlan M. Krumholz, Yale University; Philip E. Bourne, National Institutes of Health; Richard E. Kuntz, Medtronic; Harold L. Paz, Aetna; Sharon F. Terry, Genetic Alliance; and Joanne Waldstreicher, Johnson & Johnson


Innovation in Development, Regulatory Review, and Use of Clinical Advances

Authors: Michael Rosenblatt, Flagship Ventures; Christopher P. Austin, National Institutes of Health; Marc Boutin, National Health Council; William W. Chin, Pharmaceutical Research and Manufacturers of America; Steve K. Galson, Amgen, Inc.; Sachin Jain, CareMore; Michelle McMurry-Heath, Johnson & Johnson; Samuel R. Nussbaum, University of Southern California; John Orloff, R&D Biopharmaceutical Executive; Steven E. Weinberger, American College of Physicians; and Janet Woodcock, U.S. Food and Drug Administration


Targeted Research: Brain Disorders as an Example

Authors: Alan Leshner, American Association for the Advancement of Science (Ret.); Steve Hyman, Harvard University and Broad Institute of MIT; and Story Landis, National Institute of Neurological Disorders and Stroke


Training the Workforce for 21st Century Science

Authors: Elias Zerhouni, Sanofi; Jeremy Berg, University of Pittsburgh Medical Center; Freeman A. Hrabowski, University of Maryland, Baltimore County; Raynard Kington, Grinnell College; and Story Landis, National Institute of Neurological Disorders and Stroke


Synthesis Discussion Paper


Vital Directions for Health and Health Care: Priorities from a National Academy of Medicine Initiative

Authors: Victor J. Dzau, National Academy of Medicine; Mark McClellan, Duke University; Shelia Burke, Harvard Kennedy School; Molly J. Coye, AVIA; The Honorable Thomas A. Daschle, The Daschle Group; Angela Diaz, Icahn School of Medicine at Mount Sinai; The Honorable William H. Frist, Vanderbilt University; Martha E. Gaines, University of Wisconsin Law School; Margaret A. Hamburg, National Academy of Medicine; Jane E. Henney, National Academy of Medicine; Shiriki Kumanyika, University of Pennsylvania Perelman School of Medicine; The Honorable Michael O. Leavitt, Leavitt Partners; J. Michael McGinnis, National Academy of Medicine; Ruth Parker, Emory University School of Medicine; Lewis G. Sandy, UnitedHealth Group; Leonard D. Schaeffer, University of Southern California; Glenn D. Steele, xG Health Solutions; Pamela Thompson, American Organization of Nurse Executives; and Elias Zerhouni, Sanofi

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