An IOM Learning Healthcare System Workshop Preliminary Discussion Brief
March 2009

Introduction

The Institute of Medicine’s Roundtable on Evidence-Based Medicine provides a neutral venue for key stakeholders to work cooperatively on innovative approaches to the generation and application of evidence that will drive improvements in the effectiveness and efficiency of medical care in the United States. Participants seek the development of a learning healthcare system that enhances the availability and use of the best evidence for the collaborative healthcare choices of each patient and provider; drives the process of discovery as a natural outgrowth of patient care; and ensures innovation, quality, safety, and value in health care. Roundtable members have set a goal that, by the year 2020, ninety percent of clinical decisions will be supported by accurate, timely, and up-to-date clinical information, and will reflect the best available evidence on what works best for whom, under what circumstances.

While the U.S. has the highest per capita spending on health care of any industrialized nation, health outcomes lag those achieved elsewhere. The increasing costs of care are reducing access to care and constitute an ever heavier burden on employers and consumers. To address both the costs and the performance of the health care system, greater consensus will be required on what constitutes value in health care, and how to measure and increase that value. A variety of strategies are beginning to be employed throughout the health system, ranging from value-based payment design to improved systems of care delivery. To facilitate public discussion of the value proposition in health care, and how it can be advanced, the Roundtable convened a workshop on November 17-18, 2008, entitled Value in Health Care: Accounting for Cost, Quality, Safety, Outcomes and Innovation. The meeting explored the approaches to assessing and improving value, including case studies of tools that are currently being used to increase value, as well as both near-term and long-term approaches to align the system to better promote value. Its stated goal was to provide a forum for discussion of stakeholder perspectives on measuring and improving value in health care, and to identify the key barriers, opportunities and suggested next steps.

This workshop gathered leading participants from the patient, payer, provider, employer, manufacturer, government, research communities and practitioners in health insurance, the employer, health policy, economics, technology assessment, informatics, health services research, and health professions communities to consider the perspectives of key stakeholders on what constitutes value in health care, the approaches to its assessment, and ways to improve health care with respect to value returned for an investment made. Throughout the course of the workshop, a number of common themes and implications emerged, along with a number of possible follow-up actions to be considered for ongoing multi-stakeholder involvement through the IOM Roundtable on Evidence-Based Medicine. The following interim issue brief identifies these common themes as well as specific highlights from selected presentations and next steps for the Roundtable. Presentation summaries and all presentation slides are also available within the document.