The Commonwealth Fund released the “Framework for a High Performance Health System for the United States” a report today prepared by an 18 member commission formed by the Fund. Not surprisingly the commission members find that

[A]lthough some of the best medical care in the world is delivered in the United States, when examined as a whole our country falls far short of providing high-quality, safe, well-coordinated, and efficient care, accessible to all Americans—and that we are failing to deliver adequate value for the very high proportion of resources we devote to health care in this country.The report * * * states that there are concrete steps that could be taken to improve value, for example:

• Implementing major known quality and safety improvements;
• expanding the use of information technology;
• rewarding performance for quality and efficiency through our payment systems;
• increasing public reporting on quality and costs; and
• importantly, expanding health insurance coverage.

The Commission finds that central to implementing these changes is the need to establish more organized systems of care so that individual practitioners and hospitals can have:

• A structure within which to implement known quality and safety improvements;
• a structure to invest in and support appropriate information technology advances;
• a sufficiently broad base to enter into pay-for-performance contracts which reward quality and efficiency;
• the ability to provide reliable and objective public comparison of results among systems and providers; and
• the ability to care for patients across a range of needs for acute and chronic services.