Viewpoints in JAMA


Health Services Innovation – The Time is Now

“Biomedical innovation has improved prevention, diagnosis, and treatment resulting in reduction in mortality for most diseases. However, health and health care disparities remain across the life-span because these advances have not been matched by advances in delivering care, patient engagement, adherence, or access to these advanced care strategies,” writes Barry Zuckerman, M.D., of the Boston University School of Medicine, Boston, and colleagues. In this Viewpoint, the authors examine the opportunities and challenges of clinician-led innovation.

“Developing approaches to support innovation and non-incremental improvements are important to make the health system work better at the front-lines of care where patients and physicians meet. The current model of producing change through clinical research is costly and not effective at solving many modem delivery system problems. The time is now for a health services innovation incubator where physicians can rapidly address frontline health care delivery problems and improve health.”

(JAMA. 2013;309[11]:1113-1114.


Educating Physicians About Responsible Management of Finite Resources

“Despite the enormous resources at stake, physicians receive little education in how to manage and steward finite resources, making formal education of physicians in ‘program integrity’ an essential component of medical professionalism,” writes Shantanu Agrawal, M.D., of the Centers for Medicare & Medicaid Services, Baltimore, and colleagues.

“Addressing shortcomings in program integrity education will require a comprehensive solution across numerous stakeholders. This issue is central to medical professionalism and ethics because it speaks directly to the trust placed in the medical profession by patients and society. Payment reforms will no doubt alter the program integrity landscape and shift incentives, but they will not supplant the need for physician awareness. While federal and state governments are vital participants, leaders in medical education, licensure, and specialty certification would ideally work together to ensure that all physicians have sufficient awareness to safeguard public and private health care programs, patients, and themselves.”

(JAMA. 2013;309[11]:1115-1116. 

Can Accountable Care Organizations Improve Population Health? Should They Try?

Douglas J. Noble, M.D., M.P.H., and Lawrence P. Casalino, M.D., Ph.D., of Weill Cornell Medical College, New York, write that there are a number of difficult issues regarding accountable care organizations (ACOs) and the improvement of population health.

“Should ACOs be given incentives to improve the health of the population in their geographic area? Who would give these incentives? Should there be incentives for accountable health communities, and, if so, who would provide them? It will only be possible to have this debate if the phrase population health is used clearly, and not as a vague way of referring to what ACOs are currently doing.”

(JAMA. 2013;309[11]:1119-1120. 

Bridging the Divide Between Health and Health Care

Stephen M. Shortell, Ph.D., M.P.H., M.B.A., of the University of California, Berkeley, writes that “consensus is developing that truly controlling health care costs and improving the overall health of the American people will require a much closer partnership, permeable boundaries, and increased interdependence among the health care delivery system, the public health sector, and the community development and social service sectors. … If the goal is improved overall population health, all 3 sectors need to take certain actions.”

“Like a hologram in which the whole is embedded in each part, health care delivery is embedded into population health and population health is embedded into health care delivery. It is now the responsibility of clinicians and health care delivery organizations to help maintain the health of the community and the responsibility of the community to help maintain the health of the individual.”

(JAMA. 2013;309[11]:1121-1122.