The Better Care Plan: a blueprint for improving America's healthcare system.

The United States falls far short of its potential for delivering care that is effective, efficient, safe, timely, patient-centered, and equitable. We put forward the Better Care Plan, an overarching blueprint to address the flaws in our current system. The plan calls for continuously improving care, moving all payers to risk-adjusted prospective payment, and creating national entities for collecting, analyzing, and reporting patient safety and quality-of-care outcomes data. A number of recommendations are made to achieve these goals.

Ten strategies to lower costs, improve quality, and engage patients: the view from leading health system CEOs.

Patient-centeredness--the idea that care should be designed around patients' needs, preferences, circumstances, and well-being--is a central tenet of health care delivery. For CEOs of health care organizations, patient-centered care is also quickly becoming a business imperative, with payments tied to performance on measures of patient satisfaction and engagement. In A CEO Checklist for High-Value Health Care, we, as executives of eleven leading health care delivery institutions, outlined ten key strategies for reducing costs and waste while improving outcomes. In this article we describe how implementation of these strategies benefits both health care organizations and patients. For example, Kaiser Permanente's Healthy Bones Program resulted in a 30 percent reduction in hip fracture rates for at-risk patients. And at Virginia Mason Health System in Seattle, nurses reorganized care patterns and increased the time they spent on direct patient care to 90 percent. Our experiences show that patient-engaged care can be delivered in ways that simultaneously improve quality and reduce costs.

Understanding the trade-offs of the Canadian health system.

Canada spends less per citizen on health care than the United States does by maintaining tight control over prices. The Canadian government sets fee schedules for physicians, annual budgets for hospitals, and prices for prescription drugs. Caregivers also have lower incomes in Canada than in the United States. The United States needs to decide whether this combination of cost control tools would best meet the needs of U.S. citizens for universal healthcare coverage.

A proposal to cover the uninsured in California.

The lack of health coverage for millions of Californians is a major societal problem. In the absence of federal action, we propose a state-based approach that leverages existing systems to create near-universal coverage within two years. We describe several subsidized benefit options for low-income uninsured Californians, emphasizing preventive and primary care, and we propose catastrophic coverage, at a minimum, for higher-income uninsured Californians. Proposed financing mechanisms include a health care sales tax and an "in-lieu" payroll tax.

Wiring health care.

Health care is in need of an industrial revolution. To reform health care delivery, improve quality, and address the economic burdens that health care places on business and individuals in this country, we must first have access to the data that will allow us to create meaningful process improvements and reforms. Only by implementing computerized care tools can we gather the data. The government--and Medicare in particular--should fund this effort and use its purchasing power to ensure that our health care infrastructure is brought up to the level that all other key industries demand.

Healthcare tipping points.

Cost and quality are two significant tipping points that will dramatically change the healthcare environment. Major changes in the way health care is delivered and financed are expected to occur over a relatively short period. Healthcare delivery will need to be reengineered. Key to accomplishing this objective is technology.

Credibility and creativity: a conversation with Kaiser Permanente's George C. Halvorson.

In 2002 Kaiser Permanente's board surprised the industry by reaching outside its organization and selecting a nonphysician leader, George C. Halvorson, then CEO of HealthPartners of Minneapolis. In this interview Halvorson talks about returning to Kaiser's strengths--its sixty-year-plus history of integrated health care organization and its power base along the Pacific Coast--and about how he and his physician colleagues intend to leverage clinical information technology to improve their subscribers' health. Halvorson also discusses the new Medicare prescription drug legislation, the sources of the current run-up in health costs, and how he intends to position Kaiser for future growth.