The United States’ health and health care system is considered by many to be broken. Health spending is now approaching 20% of the GDP, more than $4 trillion, at least a third of which is neither needed nor useful. The paradoxical result of per capita expenditures that are double the average for comparable economies: a population health ranking below three dozen other countries. What was once viewed as a best-in-class health system has failed to deliver on the evolving understandings of the most important factors shaping health status.

The list of failures is lengthy. The majority of Americans report dissatisfaction with critical elements such as affordability, experience, and access; financial instability places hospitals across the nation at risk of closing their doors; the fiscal integrity of the Medicare program is threatened; and clinician burnout is at an all-time high. Furthermore, the devastation wrought by the COVID-19 pandemic painfully demonstrated that the system is not equipped to deliver a swift, coordinated, and effective emergency response.

At the outset of the pandemic in 2020, the National Academy of Medicine (NAM) called on members of its Leadership Consortium—composed of public and private health and health care leaders—to lead a comprehensive, real-time assessment of COVID-19’s impact on and across nine health system sectors: clinicians; patients, families, and communities; care systems; payers; public health; quality, safety, and standards organizations; research; digital health; and health product manufacturers and innovators. In addition to myriad sector-specific challenges, the work confirmed the existence of three fundamental challenges that threatened necessary performance in every sector: systemwide fragmentation, misaligned incentives, and systemic & structural inequities—plus a growing measure of distrust. Not only did these core health system vulnerabilities inhibit America’s COVID-19 response, but they continue to challenge health system improvement efforts more broadly.

To build on these learnings, the NAM has assembled the Commission on Investment Imperatives for a Healthy Nation (the Commission) to identify opportunities and priorities for creating the broad, cross-sector alignment necessary to overcome these core health system fragilities and reverse alarming trends in health system performance.

The principal work of the Commission is being conducted through working groups dedicated to five critical aspects of the alignment needed.


























What is the NAM publication, Emerging Stronger from COVID-19, and what are its key findings?

Emerging Stronger from COVID-19 is a NAM Leadership Consortium Special Publication that engaged senior leaders from nine health system sectors (ranging from patients, families, and clinicians to care organizations, public health, and research) in assessing how their respective sectors were uniquely impacted by the pandemic, as well as the innovative practices they developed as lessons on which to draw in the post-pandemic world. Perhaps most importantly, the assessments revealed that three core health system fragilities manifested in every sector, impeding a swift, coordinated, and effective COVID-19 response. They were systemwide fragmentation, misaligned incentives, and systemic & structural inequities, plus a growing measure of distrust.

How does the Commission advance the work of Emerging Stronger?

The Commission on Investment Imperatives for a Healthy Nation (the Commission) will identify opportunities and priorities for building the broad, cross-sector alignment required to overcome the core health system fragilities identified by Emerging Stronger and realize a more efficient, effective, equitable, and resilient health system. The Commission will assess the costs of maintaining the status quo; the gains that could be achieved from aligning incentives; and the policy, programmatic, and cultural changes needed to pave the way.

What are the backgrounds of the Commissioners and what is their charge?

Commissioners are well-respected and influential individuals whose collective expertise spans multiple health system sectors, public and private perspectives, and realms of lived experience. They are widely recognized as thoughtful, knowledgeable, and independent (i.e., without current health system operational responsibilities). Commissioners will review the background papers produced by each of the five Commission workstreams and put forth a set of bold recommendations for high-impact strategies to align values, incentives, policies, and actions necessary to shepherd the transformative turnaround so urgently needed in health system performance. Commissioner recommendations will be issued in a final report that will be made available to the public.

Who are the workstream working group members and what is their charge?

Each workstream is comprised of individuals with special expertise, leadership, and active involvement in the workstream’s area of focus. Workstream members are listed on each workstream’s landing page linked under the “Commission Workstreams” header above. Each workstream will produce a background paper to inform Commissioners’ deliberation on opportunities and priorities for broad, cross-sector alignment. Important elements of the background papers include one quantitative/qualitative analysis of the potential health and economic gains from achieving the workstream’s aim (and, conversely, the health and economic costs of maintaining the status quo) and a summary of the policy, programmatic, and cultural alignment levers available within the workstream’s realm of focus.

How will cross-cutting issues be engaged as they are identified?

Issues that clearly impact performance across and within each workstreams will be considered for separate analysis as they arise. For example, each workstream will reflect on workforce issues within their area of focus and a separate group will be established to consider cross-cutting implications and needs.

What is the timetable for the work?

Commission activities will take place over an initial two-year period which is now under way, with periodic progress reports and an option for staged follow-on work. The majority of workstream activities will take place within the first 18 months, beginning in Fall 2023.

What is the Philanthropic Coalition for Community Mobilization and what is its charge?

Local, state, and regional philanthropic organizations actively working on community-level health initiatives will, together, provide a platform for infusing diverse community perspectives into the Commission’s deliberation on opportunities, priorities, and strategies for cross-sector alignment for health. Coalition members may also facilitate local awareness and action on the Commission’s final recommendations, tailoring issues and approaches to their communities’ unique challenges, goals, and needs.

What is the Communication Coalition what is its charge?

Organizations and individuals with deep experience in both traditional and cutting-edge messaging strategies guide the Commission’s communications strategy and narrative-building on the critical importance of cross-sector alignment for health. The coalition seeks to ensure that the Commission’s activities and findings are accessible to and resonate with key health system stakeholders, government officials, and the public to drive demand for change.

How will information on Commission activities be regularly communicated?

Information related to the Commission and its current activities will be periodically conveyed via email newsletters. To stay informed as the work progresses, click the “Register for Updates” button at the bottom of the page.

Why is the National Academy of Medicine assuming a leadership role for this work?

The National Academy of Medicine (NAM) is a trusted source of independent knowledge and leadership in health, health care, and biomedical science. It is one of three academies—Sciences, Engineering, and Medicine (the National Academies)—operating under the 1863 Congressional charter of the National Academy of Sciences. The National Academies are private, nonprofit institutions that work outside of government to provide objective advice on issues of fundamental importance to science, technology, and health. The NAM Leadership Consortium, which is the steward for the work of the Commission, is uniquely comprised of senior leaders from over four dozen public and private institutions and is the only national-level entity focused specifically on alignment across the health system. The NAM Leadership Consortium provides a respected “safe space” for national leaders from all health system sectors to work cooperatively toward their shared commitment to the advances in science, informatics, incentives, and culture necessary for a health system that continuously learns and fosters healthier people.

How does the Commission relate to the NAM Leadership Consortium’s four Action Collaboratives?

The Commission serves as a mechanism for advancing the broad, cross-sector alignment that the NAM Leadership Consortium aims to achieve. The Leadership Consortium’s four Action Collaboratives – each dedicated to a critical component of a learning health system in which science, informatics, culture, and incentives are aligned to produce better health – are woven throughout the Commission through shared oversight and regular feedback loops to share relevant learnings. The activities of the Action Collaboratives and Commission workstreams are distinct in that Action Collaborative activities aim to advance progress toward a core set of “central solves” (i.e., root-cause issues that would eliminate a multitude of challenges if properly addressed). Commission workstreams, on the other hand, focus on quantifying the costs of action versus inaction and identifying policy, programmatic, and cultural levers for aligning values, incentives, policies, and actions within the workstream’s area of focus.

Who can provide additional information on specific Commission elements?

For Commissioner-related questions: Amanda Hunt (

Individual & Community Health Goals workstream: Asia Williams (

Inclusive, Equitable Systems workstream: Julie Tarrant (

Data & Digital Architecture workstream: Sunita Krishnan (

Funding & Accountability workstream: Amanda Hunt (

Private Equity Investment workstream: Amanda Hunt (

Philanthropic Coalition for Community Mobilization: Asia Williams (

Communications Coalition: Sunita Krishnan (

If you are interested in sponsoring the Commission, please reach out to Amanda Hunt, NAM Senior Program Officer, at

Please direction all other questions and suggestions to

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