Leadership Consortium for a Value & Science-Driven Health System
The National Academy of Medicine’s Leadership Consortium for a Value & Science-Driven Health System provides a trusted venue for national leaders in health and health care to work cooperatively toward their common commitment to effective, innovative care that consistently adds value to patients and society. Consortium Members are leaders from core stakeholder communities brought together by their common commitment to steward the advances in science, value and culture necessary for a health system that continuously learns and improves in fostering healthier people.
This work is conducted through two types of activities:1
Fostering the concepts, understanding, strategies, and progress toward a continuously learning health system2
Accelerating progress through four Innovation Collaboratives
J. Michael McGinnis, Executive Director and NAM Senior Scholar | Bio and CV
Michelle Johnston-Fleece, Senior Program Officer | MJFleece@nas.edu
Henrietta Awo Osei-Anto, Senior Program Officer | HOseiAnto@nas.edu
Danielle Whicher, Senior Program Officer | DWhicher@nas.edu
Gwen Hughes, Research Coordinator | GHughes@nas.edu
Mahnoor (Noor) Ahmed, Research Associate | MAhmed@nas.edu
Advancing health and health care through cooperative projects
Innovation Collaboratives engage key stakeholders with similar interests and field responsibilities in cooperative activities to advance science and value in health and health care. These ad hoc convening activities aim to foster sector information sharing and cooperation in accelerating the evolution of a continuously learning health system, and progress on findings highlighted in prior Academies reports of mutual priority. Innovation Collaboratives currently support activities in four overlapping and complementary areas:
Care Culture and Decision-Making | Health and communications professionals working collaboratively on providing science-driven health care and communicating effectively about best practices.
Clinical Effectiveness Research | Innovative research scientists and institutions—public, private and academic—working to improve research methods, identify priorities, and stimulate innovation.
Digital Learning | Care delivery and health information technology organizations using digital tools to accelerate the effectiveness and efficiency of care, and the real-time development of new knowledge.
Value Incentives and Systems Innovation | Medical, health care, health financing, IT and engineering organizations working to design, develop, test, and evaluate innovative, systems-based approaches to rewarding value and improving care.
Employing an inclusive, “collaborative without walls” approach—balanced with practicality around individual projects—these convening activities bring together stakeholders with mutual interests to harness their substantial talent and expertise in the identification and development of cooperative efforts most practical and strategic to field advancement.
Projects of the Innovation Collaboratives are participant identified, driven, and supported, with facilitation by Consortium staff. They vary in structure and content to meet the needs of specific issues and challenges. Some focus on identifying issues of common interest and marshaling needed leadership, expertise and resources; others aim at cooperative development of tools needed for progress; and others seek to highlight strategies, through individually authored literature summaries, technical discussions, and cooperative issue reviews. Certain activities lead to proposals for formal workshops and studies for consideration by the NAM and the Academies.
Consortium activities are both informational and project focused. Projects are participant generated and supported, NAM-staff facilitated, and participant executed and “owned.” Products are ascribed to the engaged individuals. They are not products of the NAM or the Academies. Endorsement and use is at the discretion of individual organizations.
The Patient & Family Leadership Network (PFLN) supports ongoing communication, collaboration, and synergy among patient and family thought leaders to advance their equal and full engagement across the healthcare continuum: as equal and effective partners in care decisions, at the community and organizational level through continuous improvement initiatives, and at the policy level. Learn more >>
The Executive Leadership Network for a Continuously Learning Health System (ELN) works to establish the capacity, infrastructure, and culture necessary to drive continuous learning and improvement within and across health care delivery systems by supporting ongoing communication, collaboration, and synergy among executive-level stakeholders with common investments in continuous learning. Learn more >>
First, Do No Harm: Marshaling Clinician Leadership to Counter the Opioid Epidemic
There is no question that opioid use disorder has become the fastest growing, serious, and far-reaching public health crisis facing our nation today. At the request of the National Governors Association, the National Academy of Medicine convened a group of experts and field leaders to explore clinicians’ roles in addressing opioid misuse and addiction. The resulting special publication is an action guide for clinicians if they are prescribing an opioid or managing a patient who presents with a likely opioid use disorder.
Alleviating the devastating effects this epidemic imposes on individuals, families, and communities across the nation will require determined front-line leadership from health clinicians working in every setting throughout the nation.
Effective Care for High-Need Patients: Opportunities for Improving Outcomes, Values, and Health
To advance insights and perspectives on how to better manage the care of the high-need patient population, the National Academy of Medicine, with guidance from an expert planning committee, was tasked with convening three workshops held between July 2015 and October 2016 and summarizing the presentations, discussions, and the relevant literature.
Improving care for high-need patients is not only possible–it also contributes to a more sustainable health system. But progress will take a coordinated effort from policy makers, payers, providers, and researchers, as well as patients and their loved ones.
Thousands of measures are in use today to assess health and health care in the United States. Although many of these measures provide useful information, their sheer number, as well as their lack of focus, consistency, and organization, limits their overall effectiveness in improving performance of the health system. To achieve better health at lower cost, all stakeholders—including health professionals, payers, policy makers, and members of the public—must be alert to the measures that matter most. What are the core measures that will yield the clearest understanding and focus on better health and well-being for Americans?
America’s health care system has become far too complex and costly to continue business as usual. Pervasive inefficiencies, an inability to manage a rapidly deepening clinical knowledge base, and a reward system poorly focused on key patient needs, all hinder improvements in the safety and quality of care and threaten the nation’s economic stability and global competitiveness. Achieving higher quality care at lower cost will require fundamental commitments to the incentives, culture, and leadership that foster continuous “learning”, as the lessons from research and each care experience are systematically captured, assessed, and translated into reliable care.
Integrating Research and Practice: Health System Leaders Working Toward High-Value Care: Workshop Summary
Driven by robust innovation in treatments and interventions, and by increased insights about how people vary in what works best for them, traditional approaches to clinical research are straining to keep pace with the demands. The gap might even be growing between the evidence we have and the evidence we need for best care. Improvements in electronic records and computing power, as well as novel research designs offer the prospect of drawing real-world practice and new evidence development much closer together.
Despite a robust clinical research enterprise, a gap exists between the evidence needed to support care decisions and the evidence available. Streamlined approaches to clinical research provide options for progress on these challenges. Large simple trials (LSTs), for example, generally have simple randomization, broad eligibility criteria, enough participants to distinguish small to moderate effects, focus on outcomes important to patient care, and use simplified approaches to data collection. Significant opportunities, including the wide-spread adoption of electronic health records, could accelerate the potential for the use of LSTs to efficiently generate practical evidence for medical decision making and product development.
Commentaries and Discussion Papers by members of the Leadership Consortium
Despite significant shortfalls in the overall effectiveness and efficiency of health care in the United States, many lessons are being gleaned through innovative approaches to continuous improvement sponsored in various institutions and settings. As highlighted at meetings of the Leadership Consortium for a Value & Science-Driven Health System and National Academies of Sciences, Engineering, and Medicine activities, scores of individuals across the country are engaged in activities foundational to a learning health system — with tangible results. With the possibility and the need to accelerate the dissemination of valuable practices and lessons learned, experienced and visible leaders in the field are natural messengers.
To improve awareness of applications of scientific, technologic, payment and delivery innovations that are fostering continuous learning and improvement and have already led to enhanced value in health and health care, the authors below have contributed discussion papers and commentaries which highlight their experiences, insights, and perspectives on best practices and emerging results from improvement initiatives representing progress toward a continuously learning health system.
To view all NAM Perspectives, please visit nam.edu/Perspectives.
- Richard Platt, Kathleen Blake, Patricia Franklin, J. Michael Gaziano, Robert Harrington, Adrian Hernandez, Rainu Kaushal, Andrew Masica, Janice Nevin, John Rumsfeld, and Marianne Hamilton Lopez | Clinician Engagement for Continuous Learning
- Susan B. Frampton, Sara Guastello, Libby Hoy, Mary Naylor, Sue Sheridan, Michelle Johnston-Fleece | Harnesssing Evidence and Experience to Change Culture: A Guiding Framework for Patient and Family Engaged Care
- Edward Abraham, Carlos Blanco, Celeste Castillo Lee, Jennifer B. Christian, Nancy Kass, Eric B. Larson, Madhu Mazumdar, Stephanie Morain, Katherine M. Newton, Alexander Ommaya, Bray Patrick-Lake, Richard Platt, John Steiner, Maryan Zirkle, Marianne Hamilton Lopez | Generating Knowledge from Best Care: Advancing the Continuously Learning Health System
- Nancy E. Dunlap, David J. Ballard, Robert A. Cherry, Wm. Claiborne Dunagan, Will Ferniany, Aaron C. Hamilton, Thomas A. Owens, Terry Rusconi, Steven M. Safyer, Paula J. Santrach, Abby Sears, Michael R. Waldrum and Kathleen E. Walsh | Observations from the Field: Reporting Quality Metrics in Health Care
- Bruce Bodaken, Richard Bankowitz, Timothy Ferris, Jim Hansen, John Hirshleifer, Scott Kronlund, David Labby, Rick MacCornack, Mark McClellan, and Lewis Sandy | Sustainable Success in Accountable Care
- Francisco Grajales, David Clifford, Peter Loupos, Sally Okun, Samantha Quattrone, Melissa Simon, Paul Wicks, Diedtra Henderson | Social Networking Sites and the Continuously Learning Health System: A Survey
- Julia Adler-Milstein, Gregory Daniel, Claudia Grossmann, Chad Mulvany, Rachel Nelson, Eric Pan, Valerie Rohrbach, Jonathan Perlin | Return on Information: A Standard Model for Assessing Institutional Return on Electronic Health Records
- Gary Kaplan, George Bo-Linn, Pascale Carayon, Peter Pronovost, William Rouse, Proctor Reid, Robert Saunders | Bringing a Systems Approach to Health
- Peter Hussey, Richard Bankowitz, Michael Dinneen, David Kelleher, Karen Matsuoka, Joseph McCannon, Will Shrank, Robert Saunders | From Pilots to Practice: Speeding the Movement of Successful Pilots to Effective Practice
- Sally Okun, Deven McGraw, Paul Stang, Eric Larson, Donald Goldmann, Joel Kupersmith, Rosemarie Filart, Rose Marie Robertson, Claudia Grossmann, Michael Murray | Making the Case for Continuous Learning from Routinely Collected Data
- Allen Lichter, Ross McKinney, Timothy Anderson, Erica Breese, Niall Brennan, David Butler, Eric Campbell, Susan Chimonas, Guy Chisolm, Christopher Clark, Milton Corn, Allan Coukell, Diane Dean, Susan Eringhaus, Phil Fontanarosa, Mark Frankel, Ray Hutchinson, Timothy Jost, Norm Kahn, Christine Laine, Mary LaLonde, Lorna Lynn, Patrick McCormick, Pamela Miller, Heather Pierce, Jill Hartzler Warner, Paul Weber, Dorit Zuk, Adam C. Berger, Isabelle Von Kohorn | Harmonizing Reporting on Potential Conflicts of Interest: A Common Disclosure Process for Health Care and Life Sciences
- Pamela Mitchell, Matthew Wynia, Robyn Golden, Bob McNellis, Sally Okun, C. Edwin Webb, Valerie Rohrbach, Isabelle Von Kohorn | Core Principles & Values of Effective Team-Based Health Care
- Chuck Alston, Lyn Paget, George Halvorson, Bill Novelli, Jim Guest, Patrick McCabe, Karen Hoffman, Christopher Koepke, Melissa Simon, Sharyn Sutton, Sally Okun, Paul Wicks, Tresa Undem, Valerie Rohrbach, Isabelle Von Kohorn | Communicating with Patients on Health Care Evidence
- Margaret O’Kane, Kathleen Buto, Tanya Alteras, Katherine Baicker, Judith Fifield, Robert Griffin, Jim Hansen, Robert Saunders | Demanding Value from Our Health Care: Motivating Patient Action to Reduce Waste in Health Care
- Delos Cosgrove, Michael Fisher, Patricia Gabow, Gary Gottlieb, George Halvorson, Brent James, Gary Kaplan, Jonathan Perlin, Robert Petzel, Glenn Steele, John Toussaint | A CEO Checklist for High-Value Health Care
- Harry Selker, Claudia Grossmann, Alyce Adams, Don Goldmann, Christopher Dezii, Gregg Meyer, Veronique Roger, Lucy Savitz, Rich Platt | The Common Rule and Continuous Improvement in Health Care: A Learning Health System Perspective
- Lyn Paget, Paul Han, Susan Nedza, Patricia Kurtz, Eric Racine, Sue Russell, John Santa, Mary Jean Schumann, Joy Simha, Isabelle Von Kohorn | Patient-Clinician Communication: Basic Principles and Expectations
- George Halvorson, Kaiser Permanente (former) and Bill Novelli, Georgetown | Data Altruism: Honoring Patients’ Expectations for Continuous Learning
- Scott Serota, Blue Cross and Blue Shield Association | Value-Based Care: Learnings to Shape the Future of Health Care
- Mary Naylor, University of Pennsylvania School of Nursing | Promoting Rigorous Interdisciplinary Research and Building an Evidence Base to Inform Health Care Learning, Practice, and Policy
- Risa Lavizzo-Mourey, The Robert Wood Johnson Foundation | Treating a Chronic Condition: Efforts to Reduce Avoidable Readmissions at U.S. Hospitals
- George E. Thibault and Stephen C. Schoenbaum, The Josiah Macy, Jr. Foundation | Forging Collaboration Within Academia and Between Academia and Health Care Delivery Organizations: Importance, Successes, and Future Work
- Karen Daley, American Nurses Association | A Continuously Learning Health System in the United States
- Leah Binder, The Leapfrog Group | A Few Nudges for the Choosing Wisely Campaign
- Christine K. Cassel, American Board of Internal Medicine and ABIM Foundation | Choosing Wisely: Grounded in Physician Professionalism
- Richard Platt, Harvard University; Susan Huang, University of California, Irvine; Jonathan Perlin, Hospital Corporation of America, Inc. | A Win for the Learning Health System
- Toby Cosgrove, Cleveland Clinic | Transparency: A Patient’s Right to Know
- Darrell G. Kirch, David A. Davis, Linda A. Headrick, Nancy Davis, Association of American Medical Colleges | Achieving Clinical Quality and Patient Safety: Education and Research as Critical Success Factors
- Joseph Fifer, Healthcare Financial Management Association | Creating High-Value Health Care Consumers: Toward Increased Transparency and Value
- Scott Armstrong and David Arterburn, Group Health | Creating a Culture to Promote Shared Decision Making at Group Health
- Bruce Siegel, National Association of Public Hospitals and Health Systems | Improving Quality and Patient Safety for Vulnerable Populations
- Aaron Wernham, The Pew Charitable Trusts | Ounces of Prevention: Health Impact Assessments Can Help Improve Public Policy, Health Outcomes
- Martin S. Kohn, IBM Research | Analytics in Support of Health Care Transformation
- Georges C. Benjamin, American Public Health Association| Transforming the Public Health System: What Are We Learning?
- Gary Kaplan, Virginia Mason Health System| The Lean Approach to Health Care
- Patrick Conway, Centers for Medicare & Medicaid Services| Rapid Evidence Adoption to Improve Health Outcomes
- Frederick J. Bloom, Jr., Thomas R. Graf, and Glenn D. Steele, Jr., Geisinger Health System| Improved Patient Outcomes in 3 Years with a System of Cure for Diabetes
- Senator William H. Frist, Vanderbilt University| Personalized Medicine: Innovation to Clinical Execution
- Rita Redberg, UCSF Medical Center | Less Is More
- Denis Cortese, Natalie Landman, and Robert Smoldt, Arizona State University| The First Step Toward Value-Based Health Care
- Carolyn Clancy, Agency for Healthcare Research and Quality | More Hospitals Begin to Apply Lessons from Seven Pillars Process
- Helen Darling, National Business Group on Health | Improving ROI in Health Care
- Patricia Gabow, Denver Health | The Promise of Lean Processes
- John Halamka, Harvard Medical School | Our Learning Health Care System Journey
- Janet Corrigan and Thomas Valuck, National Quality Forum | A Glide Path to High-Value Care
- Farzad Mostashari, Office of the National Coordinator for HIT | Applying Innovation to the Work of Government
- Paul Grundy, IBM | Bringing Knowledge Home
- William Bornstein and Michael Johns, Emory University | Care Transformation at Emory Healthcare
- Steven Schroeder, University of California, San Francisco | Trying to Practice What I Preached: Helping My Parents at the End of Their Lives
- David Feinberg, Molly Coye, and Eugene Washington, University of California, Los Angeles | Healing Humankind One Patient at a Time
- Bruce Bodaken, Blue Shield of California | A Path to Accountable Care
- Richard Umbdenstock, American Hospital Association | Continuous Adoption of Best Practices: The New Normal
- Robert A. Petzel, US Department of Veterans Affairs | Surgical Complexity Initiative
- Senator Tom Daschle | Controlling Costs: A Distinction and Our Choice
- Mark Chassin, The Joint Commission | Taking Aim at the Right Targets
- George Halvorson, Kaiser Permanente | Walking Our Way to Better Health
- Sheri McCoy, Johnson & Johnson (1982-2012), Avon Products, Inc. | Innovating to Improve Care and Manage Costs
- Leonard Schaeffer and Dana Goldman, University of Southern California | Benefit Design Should Reflect Value
- Donna Shalala, University of Miami | Free Employee Flu Shots Pay Prevention Dividends
To achieve better health at lower cost, all stakeholders — including health professionals, payers, policy makers, communities, and members of the public — must focus on what matters most. What are the core measures that will yield the clearest understanding of health and well-being in America? Vital Signs, a 2015 report from the Institute of Medicine, proposes a set of 15 core measures for health and health care. Explore the infographic to learn more.
Advances in health care can successfully treat and manage many diseases that were often fatal just a generation ago. Yet, our health care still falls far short of its potential and faces cost increases that are unsustainable. This infographic looks at goals for the U.S. health care system and how they might be achieves by adopting practices already in use in other industries. Explore the infographic or learn more about the IOM report Best Care at Lower Cost: The Path to Continuously Learning Health Care in America.
What matters most for improving the health of Americans and the affordability of our health care? Because what gets measured gets done, progress in health and health care depends on the measures used to guide our efforts, and our focus can be blurred without a sense of what’s most important among the thousands of measures in use across the nation. Our challenge is to identify a small, practical set of key indicators of our progress — how we are doing in achieving better health, better care, lower costs, and in involving people more in their own health and care. We need core metrics for continuously learning health and health care in America. Explore the infographic or learn more about the workshop.
The United States spends far more on health care than any other nation. In 2009, health care costs reached $2.5 trillion — nearly 17 percent of the gross domestic product. Yet, despite this spending, health outcomes in the U.S. are considerably below those in other countries. Explore the infographic or learn more about the workshop.