Improving health protection in the United States requires identifying and addressing current gaps in an effort to achieve higher standards and value without reducing access to needed care and making l organization more efficient in the process.. Efforts have been made to improve quality and value through programs such as disease management and HIT, but have had mixed success due to design flaws or interactions with problems in our system healthcare. There may be some reform options that would improve the quality and value of the U.S. healthcare system, with the goal of slowing the rate of cost growth. Say no to plagiarism. Get a tailor-made essay on "Why Violent Video Games Shouldn't Be Banned"? Get an original essay Care coordination refers to a series of reforms that reorganize primary care and add resources, with the goal of improving preventative care and transitions from one care setting to another, and exchange of information as patients navigate the healthcare system. Specifically, care coordination aims to address not just one, but multiple chronic diseases that often co-occur, particularly in patients at high risk for costly complications. Care coordination differs from DM in its focus on primary care. A typical care coordination intervention involves assigning a primary care manager to educate and monitor patients between visits, coordinate treatments and share data among each patient's multiple doctors, and remind doctors and patients the important and cost-effective treatment steps that must be taken to improve patient outcomes. Research shows that care coordination can improve quality and reduce costs, particularly when targeted at high-risk groups, including individuals who are low-income, have multiple chronic conditions, and are recently hospitalized. It will be particularly important to examine research findings from programs that combine home health reforms with other measures to support integrated care, as more integrated health care delivery systems appear to be able to achieve more significant impacts. Reforms like the one driven by Medicaid in North Carolina, which is now being extended to other payers, could be particularly instructive in this regard. As care coordination programs expand, future evaluations should analyze the cost of these interventions and compare the costs to the resulting savings. Future evaluations should also analyze the cost per QALY gained to account for the significance of health improvements. Care coordination reforms may be more likely to succeed if paired with fundamental payment reforms that promote coordination and integration. A major challenge facing the U.S. healthcare system is the lack of evidence regarding (1) the clinical effectiveness of different treatments and healthcare practices and (2) the impact of payments and other policies that appear to influence practice strategies. Relevant evidence on the effectiveness of many therapeutic alternatives is limited. There is considerable support for greater investment in comparative effectiveness research (CER) which would generate more evidence on benefits, risks and potentially costs to support healthcare decision making. The standard definition of CER refers to the clinical and economic evaluations of different medical interventions compared to alternatives forselected clinical indications and for particular patient populations. This includes comparisons of diagnostic and therapeutic interventions, for example comparing the effects of drug A with the effects of drug B for a given clinical problem or patient type, as well as alternative approaches to caring for particular patients in similar clinical settings. Other types of comparative effectiveness evidence can also be very useful for policymaking. For example, because most variations in practice that account for variations in costs do not relate to specific differences in cost treatments, defining CER more broadly to include comparisons of practice strategies might also provide more direct and useful guidance for influence these practices. Reform proposals often focus exclusively on extending coverage to uninsured Americans, but coverage expansions will be less costly and more beneficial if they are combined with distribution reforms. Conversely, reform's effectiveness will be limited if it does not address the substantial underutilization of valuable care among the uninsured. Therefore, coverage expansion and delivery reforms should be pursued together. Integrated delivery reforms are likely to increase health care quality and reduce cost growth. These improvements would prompt some uninsured Americans to purchase coverage and some Americans on Medicaid to switch to private insurance. To change how care is delivered, a critical element of healthcare reform includes the transition to payment systems for providers and patient benefit systems that directly support better value. Information systems must enable patient-centered care. While this appeared to be the premise of electronic health records, in reality most have focused on improving billing, revenue, and documentation, rather than accurately tracking individual patients' health, well-being, outcomes, and costs throughout the entire continuum of care. In the healthcare system of the future, patient-centric electronic health records must be easily accessible to all healthcare professionals, as well as to the patients themselves; it must be easy to insert and extract data; and must use common definitions for the data. Such electronic health records should be welcomed by hospitalists and should do whatever it takes to achieve outcomes in the healthcare system. Care should be integrated into fewer large delivery systems, rather than large numbers of small, “do-it-all” systems. These large systems must actually work for the good of patients by integrating their care and not simply providing duplicate services in each location. Each center should be able to provide excellent care in some conditions, but not adequate care in all conditions. More complicated and complex care should be provided in tertiary care centers, while more predictable and less heterogeneous care conditions should be addressed in low-cost community settings. Integrated systems can direct the right patients to the right place, to improve both quality and costs. Reimbursement for services should reflect the actual cost of the service and should be bundled. Many hospitalists are likely already involved in some demonstration projects on bundled payments for care across a continuum. Many CMS demonstration projects have focused on predictable high-volume conditions (total hip arthroplasty, for example) or high-volume conditions, less 22, 2013.