On September 6, 2012, the Institute of Medicine (IOM) released a new seminal report, entitled: “Best Care at Lower Cost: The Path to Continuously Learning Health Care in America” (Report).  Building upon its earlier works, including: “To Err is Human” (1999); “Crossing the Quality Chasm” (2001); and, “Unequal Treatment” (2002), this latest report may stimulate even greater improvement in the healthcare system than the IOM’s previous reports were able to accomplish.¹ While previous reports focused on specific problems within the system, such as quality, safety, and disparities in care, this Report discusses what the authoring committee (Committee) deems to be the overarching problem facing the healthcare system today: insufficient learning and adoption of the techniques and processes that will improve the healthcare system in each of these areas and as a whole.² Through a series of recommendations, the Report outlines ways in which various stakeholders should collaborate to improve the way the healthcare system learn.

In addition to quality and cost control, the Report focuses on the overriding issue of complexity that has developed as a result of the huge gains achieved in clinical and biomedical knowledge over the past fifty years.³  Scientific and technological advances have improved providers’ capability to understand and treat illness, and yet, the volume of these discoveries has inundated the healthcare system and hindered its ability to deliver care.⁴  Because of the way providers are trained and updated, as well as utilized and paid, the healthcare system as a whole has been unable to effectively absorb the vast amount of information gained, which in turn impacts both quality and costs through inconsistent adoption, fragmented care, and the provision of unnecessary services.⁵ The Committee emphasized three crucial objectives for making the healthcare system one that continuously learns: seizing technological, policy, and industry opportunities; realizing greater value; and, managing the increasingly complex nature of healthcare.⁶ In order to achieve these objectives, the Committee made ten recommendations, which fall into three categories: foundational elements; care improvement targets; and, supportive policy environment.⁷

Among the Committee’s ten recommendations are two foundational elements designed to enhance the capture and use of clinical and financial data in order to generate new knowledge and improve systems.⁸ There are five care improvement targets that focus on the promotion of patient-centered care; the use of clinical decision support to integrate best clinical knowledge into care decisions; and, the promotion of community-clinical partnerships to improve community health.⁹ In the policy environment, the Committee made three recommendations that emphasize greater transparency on the performance of healthcare systems and the use of broad leadership and financial incentives to both promote and reward “continuous learning and improvement in the provision of best care at lower cost.”¹⁰ For each of the recommendations, the Committee also identified stakeholders necessary to implementation, and these include a broad range of individuals and groups, such as the Secretary of Health and Human Services; public and private payers; research and advocacy organizations; patient and consumer groups; health economists; health professional education programs; and, healthcare delivery organizations and clinicians.¹¹ Through strategies that engage key participants and aim to implement best practices with respect to data usage; clinical care; delivery processes; and, performance measurement, the Report provides a holistic guide to achieving overall improvement of the healthcare system.¹²

In consideration of the ever-growing focus on obtaining greater value in healthcare, this Report purports to outline a plan to develop a “learning” healthcare system that will improve quality and achieve greater value.¹³ The chair of the Committee emphasized that using fewer resources does not have to translate to lower quality, and that the amount of money spent is not the primary concern, but rather, developing the right policies in order to deliver the right care.¹⁴ Recent data suggests that if every state delivered the same level of quality as that provided in the highest performing state, 75,000 fewer deaths could have resulted across the country in 2005, and given this amount of lower-quality care and the estimate of $750 billion in wasted healthcare resources for 2009, there is substantial room in which to improve the value of Americans’ healthcare.¹⁵ The Report is the first known attempt to address the complexity of healthcare in addition to quality and cost concerns, and it emphasizes that this complexity requires stakeholder collaboration and continuous learning in order to produce an improved healthcare system and achieve the ultimate goal: “best care at lower cost.”¹⁶

With this Report, the IOM has provided a comprehensive road map to developing a healthcare system that learns and evolves in order to provide the greatest value in healthcare. Despite significant advances in individual hospitals, health systems, and even states, a widespread, concerted effort is required to achieve meaningful and lasting change.¹⁷ The Report outlined specific strategies and identified the necessary stakeholders, so all that remains to be seen is where and with whom adoption and implementation will begin.