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

Importance: Recent discussion has focused on questions related to the repeal and replacement of portions of the Affordable Care Act (ACA). However, issues central to the future of health and health care in the United States transcend the ACA provisions receiving the greatest attention. Initiatives directed to certain strategic and infrastructure priorities are vital to achieve better health at lower cost.

Toward a 21st-century health care system: recommendations for health care reform.

The coverage, cost, and quality problems of the U.S. health care system are evident.

The new architects of health care reform.

Rising health care costs have been an issue for decades, yet federal-level health care reform hasn't happened. Support for reform, however, has changed. Purchasers fear that health care cost growth is becoming unaffordable.

Variation in medical care: time for action.

Variations research has broken new ground by moving analysis of Medicare data from the community to the hospital level. The California study of hospitals further illustrates the power of comparing performance to demonstrate the levels of efficiency that can be achieved. WellPoint, replicating the Dartmouth approach with its commercial data, is partnering with medical specialty societies to make data "actionable" and move beyond benchmarking to help providers alter practice patterns.

When excuses run dry: transforming the U.S. health care system.

Mainstream media have reported on the wide variation in clinical practice documented for years by health service researchers. Raising awareness of the quality and cost implications of clinical variation, however, is not enough to adopt clinical behavior based on the principles of evidence-based medicine (EBM). Preoccupation with EBM's limitations--which can be overcome--and failure to address its misperceptions inhibit transformation to an evidence-based system of care and payment.

The leadership journey.

It isn't always easy to change leadership hats or to alter the way you assess a business problem. Under pressure, most executives fall back on the management style or approach that worked in the last crisis they faced. But old approaches rarely work in new and demanding situations.