What can be more vital to each of us than our health? Yet, despite unprecedented health care spending, the U.S. health system is substantially underperforming, especially with respect to what should be possible, given current knowledge. Although the United States is currently devoting 18% of its Gross Domestic Product to delivering medical care—more than $3 trillion annually and nearly double the expenditure of other advanced industrialized countries—the U.S. health system ranked only 37 in performance in a World Health Organization assessment of member nations. In Vital Directions for Health & Health Care: An Initiative of the National Academy of Medicine, the National Academy of Medicine (NAM), which has long stood as the nation’s most trusted independent source of guidance in health, health care, and biomedical science, has marshaled the wisdom of more than 150 of the nation’s best researchers and health policy experts to assess opportunities for substantially improving the health and well-being of Americans, the quality of care delivered, and the contributions of science and technology. This publication identifies practical and affordable steps that can and must be taken across eight action and infrastructure priorities, ranging from paying for value and connecting care, to measuring what matters most and accelerating the capture of real-world evidence. Without obscuring the difficulty of the changes needed, in Vital Directions, the NAM offers an important blueprint and resource for health, policy, and leaders at all levels to achieve much better health outcomes at much lower cost.

Contents

• ABOUT THE NATIONAL ACADEMY OF MEDICINE
• VITAL DIRECTIONS FOR HEALTH & HEALTH CARE
• REVIEWERS
• PREFACE
• ACKNOWLEDGMENTS
• 1. VITAL DIRECTIONS FOR HEALTH AND HEALTH CARE: PRIORITIES FROM A NATIONAL ACADEMY OF MEDICINE INITIATIVE
  • CONTEXT: FUNDAMENTAL CHALLENGES
  • CONTEXT: REALISTIC TOOLS
  • THE NATIONAL ACADEMY OF MEDICINE INITIATIVE
  • VITAL DIRECTIONS FOR HEALTH AND HEALTH CARE: THE PRIORITIES
  • THE ACTION PRIORITIES
  • ESSENTIAL INFRASTRUCTURE NEEDS
  • THE PATH FORWARD
  • REFERENCES
  • AUTHOR INFORMATION
• I. BETTER HEALTH AND WELL-BEING
  • 2. SYSTEMS STRATEGIES FOR BETTER HEALTH THROUGHOUT THE LIFE COURSE
    • HEALTH AND DISEASE OVER THE LIFE COURSE
    • THE DETERMINANTS OF HEALTH
    • CAUSES AND CONSEQUENCES OF SYSTEM SHORTFALLS
    • POTENTIALLY TRANSFORMATIVE SYSTEM PARTNERSHIPS
    • VITAL DIRECTIONS
    • CONCLUSION
    • REFERENCES
    • AUTHOR INFORMATION
  • 3. ADDRESSING SOCIAL DETERMINANTS OF HEALTH AND HEALTH DISPARITIES
    • OVERVIEW
    • KEY ISSUES, COST IMPLICATIONS, AND BARRIERS TO PROGRESS
    • CONCLUSION
    • REFERENCES
    • AUTHOR INFORMATION
  • 4. PREPARING FOR BETTER HEALTH AND HEALTH CARE FOR AN AGING POPULATION
    • KEY TRENDS IN DEMOGRAPHY AND HEALTH EQUITY IN THE 21ST CENTURY
    • KEY OPPORTUNITIES FOR PROGRESS
    • STRENGTHENING THE ELDER CARE WORKFORCE
    • SOCIAL ENGAGEMENT AND WORK-RELATED STRATEGIES TO ENHANCE HEALTH IN LATE LIFE
    • ADVANCED ILLNESS AND END-OF-LIFE CARE
    • VITAL DIRECTIONS
    • REFERENCES
    • AUTHOR INFORMATION
  • 5. CHRONIC DISEASE PREVENTION: TOBACCO, PHYSICAL ACTIVITY, AND NUTRITION FOR A HEALTHY START
    • THE MAGNITUDE OF THE CHALLENGE: KEY ISSUES AND COST IMPLICATIONS
    • OPPORTUNITIES FOR PROGRESS AND POLICY IMPLICATIONS
    • VITAL DIRECTIONS
    • REFERENCES
    • AUTHOR INFORMATION
  • 6. IMPROVING ACCESS TO EFFECTIVE CARE FOR PEOPLE WHO HAVE MENTAL HEALTH AND SUBSTANCE USE DISORDERS
    • BARRIERS TO SERVICE DELIVERY AND COORDINATION
    • FACILITATORS OF POTENTIAL IMPROVEMENTS IN CARE
    • VITAL DIRECTIONS
    • CONCLUSIONS AND SUMMARY
    • REFERENCES
    • AUTHOR INFORMATION
  • 7. ADVANCING THE HEALTH OF COMMUNITIES AND POPULATIONS
    • OPPORTUNITIES FOR PROGRESS AND POLICY IMPLICATIONS: A CALL FOR CHANGE
    • GOAL 1: SUPPORT STRONG NATIONAL PUBLIC HEALTH OBJECTIVES WITH LEADERSHIP AND INVESTMENTS
    • GOAL 2: PROMOTE EFFORTS BY HEALTH CARE ORGANIZATIONS AND SYSTEMS IN ADVANCING COMMUNITY AND TOTAL POPULATION HEALTH
    • GOAL 3: ADDRESS SOCIAL AND ENVIRONMENTAL DETERMINANTS OF HEALTH IN COMMUNITIES
    • GOAL 4: TRANSLATE EVIDENCE INTO ACTION
    • CONCLUSION
    • REFERENCES
    • AUTHOR INFORMATION
• II. HIGH-VALUE HEALTH CARE
  • 8. BENEFIT DESIGN TO PROMOTE EFFECTIVE, EFFICIENT, AND AFFORDABLE CARE
    • CONCEPTUAL ISSUES
    • EXISTING OPPORTUNITIES FOR PROGRESS
    • BARRIERS TO PROGRESS
    • POLICY IMPLICATIONS
    • VITAL DIRECTIONS
    • REFERENCES
    • AUTHOR INFORMATION
  • 9. PAYMENT REFORM FOR BETTER VALUE AND MEDICAL INNOVATION
    • PAYMENT REFORM INITIATIVES AND STAKEHOLDER CONTRIBUTIONS
    • CHALLENGES AND BARRIERS TO PAYMENT REFORM
    • SAFEGUARDING AGAINST UNINTENDED CONSEQUENCES
    • VITAL DIRECTIONS
    • REFERENCES
    • AUTHOR INFORMATION
  • 10. COMPETENCIES AND TOOLS TO SHIFT PAYMENTS FROM VOLUME TO VALUE
    • CHALLENGES TO AND PROGRESS TOWARD DEFINING AND SUPPORTING COMPETENCIES FOR VALUE-BASED HEALTH CARE
    • ACCELERATING THE DEVELOPMENT OF HEALTH CARE CAPABILITIES TO SUCCEED IN VALUE-BASED PAYMENT MODELS
    • VITAL DIRECTIONS
    • CONCLUSION
    • REFERENCES
    • AUTHOR INFORMATION
  • 11. TAILORING COMPLEX-CARE MANAGEMENT, COORDINATION, AND INTEGRATION FOR HIGH-NEED, HIGH-COST PATIENTS
    • OVERVIEW OF HIGH-NEED, HIGH-COST PATIENTS
    • POPULATION SEGMENTATION: A CRITICAL FIRST STEP TO MATCH INTERVENTIONS TO PATIENTS' NEEDS
    • WHAT WORKS? LESSONS FROM THE LITERATURE ON PROMISING MODELS FOR THE HIGH-NEED, HIGH-COST POPULATION
    • CHALLENGES TO SPREAD AND SCALE
    • VITAL DIRECTIONS
    • CONCLUSION
    • REFERENCES
    • AUTHOR INFORMATION
  • 12. REALIZING THE FULL POTENTIAL OF PRECISION MEDICINE IN HEALTH AND HEALTH CARE
    • OVERVIEW AND STATE OF SCIENCE
    • KEY ISSUES, BARRIERS TO, AND OPPORTUNITIES FOR PROGRESS
    • VITAL DIRECTIONS
    • REFERENCES
    • AUTHOR INFORMATION
  • 13. FOSTERING TRANSPARENCY IN OUTCOMES, QUALITY, SAFETY, AND COSTS
    • KEY ISSUES, COST IMPLICATIONS, AND BARRIERS TO PROGRESS
    • OPPORTUNITIES FOR PROGRESS AND POLICY IMPLICATIONS
    • CONCLUSION
    • VITAL DIRECTIONS
    • REFERENCES
    • AUTHOR INFORMATION
  • 14. THE DEMOCRATIZATION OF HEALTH CARE
    • KEY ISSUES
    • VITAL DIRECTIONS
    • CONCLUSION
    • REFERENCES
    • AUTHOR INFORMATION
  • 15. WORKFORCE FOR 21ST-CENTURY HEALTH AND HEALTH CARE
    • THE POPULATION IN GOOD HEALTH: A WORKFORCE TO KEEP PEOPLE HEALTHY AND TO PROMOTE POPULATION HEALTH
    • THE POPULATION THAT HAS ACUTE ILLNESS OR INJURY: A WORKFORCE TO CARE FOR PEOPLE WHO EXPERIENCE MAJOR EPISODES OF ILLNESS OR INJURY
    • THE POPULATION THAT HAS CHRONIC DISEASE AND MULTIPLE COMORBIDITIES: A WORKFORCE TO SERVE PEOPLE WHO HAVE CHRONIC MEDICAL OR BEHAVIORAL CONDITIONS
    • THE POPULATION FACING DEATH AND DYING: A WORKFORCE TO CARE FOR PEOPLE AT THE END OF LIFE
    • VITAL DIRECTIONS
    • REFERENCES
    • AUTHOR INFORMATION
• III. STRONG SCIENCE AND TECHNOLOGY
  • 16. INFORMATION TECHNOLOGY INTEROPERABILITY AND USE FOR BETTER CARE AND EVIDENCE
    • KEY ISSUES
    • CONCLUSION
    • VITAL DIRECTIONS
    • REFERENCES
    • AUTHOR INFORMATION
  • 17. DATA ACQUISITION, CURATION, AND USE FOR A CONTINUOUSLY LEARNING HEALTH SYSTEM
    • TOPIC OVERVIEW, ISSUES, AND TRENDS
    • PROGRESS
    • CHALLENGES
    • PRIORITY CONSIDERATIONS
    • POTENTIAL METRICS
    • CONCLUSION
    • REFERENCES
    • AUTHOR INFORMATION
  • 18. INNOVATION IN DEVELOPMENT, REGULATORY REVIEW, AND USE OF CLINICAL ADVANCES
    • CONTEXT AND TYPES OF OPPORTUNITIES
    • DISCOVERY OF NEW THERAPIES
    • DEVELOPMENT OF NEW THERAPIES
    • CLINICAL TRIAL EXECUTION
    • REGULATORY REVIEW
    • PATIENT-CENTERED PRODUCT DEVELOPMENT
    • SPEEDING THE UPTAKE OF MEDICAL ADVANCES INTO CLINICAL PRACTICE
    • EDUCATING THE PUBLIC, POLICYMAKERS, AND THE MASS MEDIA ABOUT CLINICAL DATA AND TRIALS
    • CONCLUSIONS
    • VITAL DIRECTIONS
    • REFERENCES
    • AUTHOR INFORMATION
  • 19. TARGETED RESEARCH: BRAIN DISORDERS AS AN EXAMPLE
    • POLICY STRATEGIES
    • BRAIN DISORDERS ARE RIPE FOR SPECIAL ATTENTION
    • ELEMENTS OF AN INITIATIVE ON BRAIN DISORDERS
    • REFERENCES
    • AUTHOR INFORMATION
  • 20. TRAINING THE WORKFORCE FOR 21ST-CENTURY SCIENCE
    • THE HIGH SCHOOL EXPERIENCE
    • THE UNDERGRADUATE EXPERIENCE
    • THE GRADUATE EXPERIENCE
    • THE POSTGRADUATE EXPERIENCE
    • THE POSTDOCTORAL EXPERIENCE
    • KEY ISSUE: THE CHALLENGE OF ATTRACTING AND RETAINING THE BEST AND THE BRIGHTEST IN THE 21ST CENTURY
    • POLICY SUGGESTIONS
    • CONCLUSION
    • NOTE
    • REFERENCES
    • AUTHOR INFORMATION
• APPENDIXES
  • APPENDIX A. VITAL DIRECTIONS STEERING COMMITTEE BIOGRAPHIES
  • APPENDIX B. RELATED PUBLICATIONS FROM THE NATIONAL ACADEMIES OF SCIENCES, ENGINEERING, AND MEDICINE
  • APPENDIX C. VITAL DIRECTIONS FOR HEALTH AND HEALTH CARE: A NATIONAL CONVERSATION

Suggested citation:

Dzau, V. J., M. McClellan, J. M. McGinnis, and E. M. Finkelman, editors. 2017. Vital directions for health & health care: An initiative of the National Academy of Medicine. Washington, DC: National Academy of Medicine.

Support for the NAM's Vital Directions for Health & Health Care Initiative was provided by the California Health Care Foundation, The Commonwealth Fund, the Gordon and Betty Moore Foundation, The John A. Hartford Foundation, the Josiah Macy Jr. Foundation, the Robert Wood Johnson Foundation, and the NAM's Harvey V. Fineberg Impact Fund.

Library of Congress Cataloging-in-Publication Data

Names: Dzau, Victor J., editor. | McClellan, Mark B., editor. | McGinnis, J. Michael, editor. | Finkelman, Elizabeth, editor. | National Academy of Medicine (U.S.), issuing body.

Title: Vital directions for health and health care : an initiative of the National Academy of Medicine / Victor J. Dzau, Mark McClellan, J. Michael McGinnis, Elizabeth Finkelman, editors.

Description: Washington, DC : National Academy of Medicine, [2017] | Includes bibliographical references.

Identifiers: LCCN 2017034965 (print) | LCCN 2017036005 (ebook) | ISBN 9781947103016 (ebook) | ISBN 9781947103009 (pbk.)

Subjects: | MESH: Health Policy | United States

Classification: LCC RA418 (ebook) | LCC RA418 (print) | NLM WA 540 AA1 | DDC 362.1--dc23

LC record available at https://lccn.loc.gov/2017034965

Printed in the United States of America.

“Knowing is not enough; we must apply.

Willing is not enough; we must do.”

—GOETHE