In the current issue, JAMA editors highlight five viewpoints, including their own editorial, on solutions to the state of health care in America. The standout comes from Don Berwick, M.D., who suggests that that there has been two eras in healthcare: one marked by ascendancy and “professional trust and prerogative, to the current era of “Accountability, scrutiny, measurements, incentives and markets.” What is needed, Berwick argues, is a third era, marked in part by:

  • Reduced mandatory measurement: “The aim should be to measure only what matters, and mainly for learning.”

  • Stop complex individual incentives: “Aligning payment systems and incentives with triple aim goals for organizations makes sense, but payers and health care executives should declare a moratorium on complex incentive programs for individual clinicians, which are confusing, unstable, and invite gaming.”

  • Shift the business strategy from revenue to value: “A better, more sustainable route to financial success is improving quality.”

  • Give up professional prerogative when it hurts the whole: “The romantic image of the totally self-sufficient physician no longer serves professionals or patients well.”

Berwick says a third era will include the use of improvement science for better outcomes, ending barriers to complete transparency, a focus on patient-centered care, and a call for fair pricing of products and services.

Berwick’s editorial can be read here.


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