Perspective:

There is now an unprecedented opportunity to create a high-performance health system in the United States. Recent statutes and acts provide the federal government with important powers for catalyzing improvement in service delivery. These new powers touch on all the critical levers for advancing health system performance: payment policy, organization and infrastructure, public health, and essential information for health care decision making. To improve health system performance, government leadership for performance improvement requires clear goals, beginning with concrete cost-containment and quality improvement targets. The guiding vision should be based on the understanding that performance improvement requires that clinicians and patients be provided the best available information when and where they need it, and making it easy to do the right thing. One potential approach is that the federal government work with other stakeholders to launch a nationwide, community-based initiative to improve the care of high-cost patients with multiple chronic conditions. This program should recruit 50-100 geographic areas or health improvement communities, encompassing a substantial segment of the US population. At this time, the federal government and its private and public partners need to leave business as usual behind, and create and implement a plan that addresses the root causes of our health care crisis expediently.