Vital Directions for Health & Health Care

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^th 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 U.S. National Academy of Medicine (NAM, formerly the Institute of Medicine), 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.

 1. Vital Directions for Health and Health Care: Priorities from a National Academy of Medicine Initiative   1

PART I: BETTER HEALTH AND WELL-BEING

 2. Systems Strategies for Better Health Throughout the Life Course    43

 3. Addressing Social Determinants of Health and Health Disparities    71

 4. Preparing for Better Health and Health Care for an Aging Population    97

 5. Chronic Disease Prevention: Tobacco, Physical Activity, and Nutrition for a Healthy Start    111

 6. Improving Access to Effective Care for People Who Have Mental Health and Substance Use Disorders   135

 7. Advancing the Health of Communities and Populations   153

PART II: HIGH-VALUE HEALTH CARE

 8. Benefit Design to Promote Effective, Efficient, and Affordable Care   175

 9. Payment Reform for Better Value and Medical Innovation    191

 10. Competencies and Tools to Shift Payments from Volume to Value    221

 11. Tailoring Complex-Care Management, Coordination, and Integration for High-Need, High-Cost Patients   233

 12. Realizing the Full Potential of Precision Medicine in Health and Health Care   249

 13. Fostering Transparency in Outcomes, Quality, Safety, and Costs    269

 14. The Democratization of Health Care   289

 15. Workforce for 21st-Century Health and Health Care   301

PART III: STRONG SCIENCE AND TECHNOLOGY

 16. Information Technology Interoperability and Use for Better Care and Evidence    319

 17. Data Acquisition, Curation, and Use for a Continuously Learning Health System    345

 18. Innovation in Development, Regulatory Review, and Use of Clinical Advances   369

 19. Targeted Research: Brain Disorders as an Example    395

 20. Training the Workforce for 21st-Century Science   407

APPENDIXES

A. Vital Directions Steering Committee Biographies   433

B. Related Publications from the National Academies of Sciences, Engineering, and Medicine   449

C. “Vital Directions for Health & Health Care: A National Conversation” Symposium Agenda (September 26, 2016)  469