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Since its founding, the Center for Medicare & Medicaid Innovation (CMMI) has tested more than 50 alternative payment models reaching more than 28 million patients across 528,000 health care providers and plans, yielding invaluable insights on the implementation of models to achieve better care, better health, and lower costs. On the other hand, many basic lessons learned are lessons unapplied. U.S. population health outcomes lag behind its highly economically developed peers and our health system is still firmly entrenched in the fee-for-service payment system that rewards service volume. This Special Publication suggests six key priority actions for CMMI centered on signaling, mapping, measuring, modeling, partnering, and demonstrating. These priority actions, coupled with implementation considerations that focus on meaningful and continuous engagement, intersectionality and diversity, and expanding CMMI activities and impact, are intended to assist in aligning, supporting, and informing the implementation of CMMI's Strategic Refresh.

One Nation, Uninsured offers a vividly written history of America's failed efforts to address the health care needs of its citizens. Covering the entire twentieth century, Jill Quadagno shows how each attempt to enact national health insurance was met with fierce attacks by powerful stakeholders, who mobilized their considerable resources to keep the financing of health care out of the government's hands.

CONTEXT: Health system reform plan refers to conducting some fundamental, systematic, and sustainable changes. AIMS: The aim of the present study was to evaluate different required inputs of Iran Health Transformation Plan from experts' viewpoints. SETTINGS AND DESIGN: The data of this qualitative study were collected using semi-structured interviews. SUBJECTS AND METHODS: The purposive sampling method led to 18 participant selection and then they were interviewed. Interviewees were assured about confidentiality of information. STATISTICAL ANALYSIS USED: The thematic analysis method and MAXQDA software were employed for analyzing the data. RESULTS: There were 4 main themes and 35 subthemes extracted including management requirements for health development plan, human resources, information resources, and financial resources. Each theme had subthemes such as “resource allocation,” “development of required standards for human resources,” “human resources' motivation,” “failures in IT infrastructures,” “hospital information management software,” “guidelines and instructions,” “costs controlling,” and “financing the plan”. CONCLUSIONS: Results of the present study put significant emphasis on the path of improving the effectiveness and efficacy of applying the discussed inputs, which can be a light for revising past policies and taking better future steps, it also can be a resource guide for policy-makers and managers of the health-care system.

Interprofessional teamwork and collaborative practice are emerging as key elements of efficient and productive work in promoting health and treating patients. The vision for these collaborations is one where different health and/or social professionals share a team identity and work closely together to solve problems and improve delivery of care. Although the value of interprofessional education (IPE) has been embraced around the world - particularly for its impact on learning - many in leadership positions have questioned how IPE affects patent, population, and health system outcomes. This question cannot be fully answered without well-designed studies, and these studies cannot be conducted without an understanding of the methods and measurements needed to conduct such an analysis. This Institute of Medicine report examines ways to measure the impacts of IPE on collaborative practice and health and system outcomes. According to this report, it is possible to link the learning process with downstream person or population directed outcomes through thoughtful, well-designed studies of the association between IPE and collaborative behavior. Measuring the Impact of Interprofessional Education on Collaborative Practice and Patient Outcomes describes the research needed to strengthen the evidence base for IPE outcomes. Additionally, this report presents a conceptual model for evaluating IPE that could be adapted to particular settings in which it is applied. Measuring the Impact of Interprofessional Education on Collaborative Practice and Patient Outcomes addresses the current lack of broadly applicable measures of collaborative behavior and makes recommendations for resource commitments from interprofessional stakeholders, funders, and policy makers to advance the study of IPE.

The current approach to patient safety, labelled Safety I, is predicated on a 'find and fix' model. It identifies things going wrong, after the event, and aims to stamp them out, in order to ensure that the number of errors is as low as possible. Healthcare is much more complex than such a linear model suggests. We need to switch the focus to what we have come to call Safety II: a concerted effort to enable things to go right more often. The key is to appreciate that healthcare is resilient to a large extent, and everyday performance succeeds much more often than it fails. Clinicians constantly adjust what they do to match the conditions. Facilitating work flexibility, and actively trying to increase the capacity of clinicians to deliver more care more effectively, is key to this new paradigm. At its heart, proactive safety management focuses on how everyday performance usually succeeds rather than on why it occasionally fails, and actively strives to improve the former rather than simply preventing the latter.

Can American health insurance survive? In The Transformation of American Health Insurance, Troyen A. Brennan traces the historical evolution of public and private health insurance in the United States from the first Blue Cross plans in the late 1930s to reforms under the Biden administration. In analyzing this evolution, he finds long-term trends that form the basis for his central argument: that employer-sponsored insurance is becoming unsustainably expensive, and Medicare for All will emerge as the sole source of health insurance over the next two decades. After thirty years of leadership in health care and academia, Brennan argues that Medicare for All could act as a single-payer program or become a government-regulated program of competing health plans, like today's Medicare Advantage. The choice between these two options will depend on how private insurers adapt and behave in today's changing health policy environment. This critical evolution in the system of financing health care is important to employers, health insurance executives, government officials, and health care providers who are grappling with difficult strategic choices. It is equally important to all Americans as they face an inscrutable health insurance system and wonder what the future might hold for them regarding affordable coverage.

Context: Medical care in rural China has long suffered because of a concentration of medical resources in major hospitals in cities. The patients in rural areas thus do not have affordable access to quality medical services. To tackle such issues, a tiered medical scheme (TMS) was promoted by the Chinese State Council in 2015. It divides hospitals into three tiers and encourages collaborations among different tiers within a region in order to provide better accessibility to medical care for patients in rural areas. Issues: The implementation of the TMS policy has not been successful, because the previous funding model, which allocated funding to each hospital according to the number of patients treated, did not facilitate close collaborations between different hospitals. In this report, the medical service unity (MSU) approach, which has been piloted in Funan county, is reported. The MSU organises the tiered hospitals as a unity in terms of medical capabilities and financial abilities. With the radical reform of financial decentralisation, three flows are thereby enabled: the funding flow binds together the hospitals into a unity, the patient flow shares the load across the providers and eases barriers to access, and the resource flow ensures accessibility and affordability for patients. Lessons learned: The MSU approach has been shown by the pilot project in Funan to be effective for the realisation of the TMS policy, benefiting hospitals, doctors and patients. The successful experience of the Funan MSU could be introduced to other regions across China and other countries. In particular, future finance reform policies for the health system would largely benefit the health reforms and especially the decentralisation of medical resources to rural areas.

A blueprint for comprehensive, science-based health care system reform.Financial and political pressures on our health care system have negatively impacted individual care and the health system as a whole, an issue that has only become more acute because of the COVID-19 pandemic. In Building a Unified American Health Care System, Gilead I Lancaster, MD, lays out a blueprint for comprehensive health care reform, proposing a unified system run by health care professionals—not politicians or commercial health insurance companies—that offers universal coverage and access.Lancaster compares the current arguments for single payer versus commercial health insurance systems with arguments in the early 1900s for a central bank versus regional commercial banks. He then introduces a novel solution: the establishment of a National Medical Board similar to the Federal Reserve System that helped fix the American banking system over a century ago. Along with other innovations, a plan co-created by Lancaster dubbed EMBRACE (Expanding Medical and Behavioral Resources with Access to Care for Everyone) would involve creating a modern, evidence-based health care system, one offering universal coverage for basic needs while allowing for commercial insurance participation. Emphasizing the importance of separating health care from governmental and commercial pressures and incentives, Lancaster explains the need for comprehensive—rather than incremental—reform of the American health care system.

Background Effective governance arrangements are central to the successful functioning of health systems. While the significance of governance as a concept is acknowledged within health systems research, its interplay with health system reform initiatives remains underexplored in the literature. This study focuses on the development of new regional health structures in Ireland in the period 2018–2023, one part of a broader health system reform programme aimed at greater universalism, in order to scrutinise how aspects of governance impact on the reform process, from policy design through to implementation. Methods This qualitative, multi-method study draws on document analysis of official documents relevant to the reform process, as well as twelve semi-structured interviews with key informants from across the health sector. Interviews were analysed according to thematic analysis methodology. Conceiving governance as comprising five domains (Transparency, Accountability, Participation, Integrity, Capacity) the research uses the TAPIC framework for health governance as a conceptual starting point and as initial, deductive analytic categories for data analysis. Results The analysis reveals important lessons for policymakers across the five TAPIC domains of governance. These include deficiencies in accountability arrangements, poor transparency within the system and vis-à-vis external stakeholders and the public, and periods during which a lack of clarity in terms of roles and responsibilities for various process and key decisions related to the reform were identified. Inadequate resourcing of implementation capacity, competing policy visions and changing decision-making arrangements, among others, were found to have originated in and continuously reproduced a lack of trust between key institutional actors. The findings highlight how these challenges can be addressed through strengthening governance arrangements and processes. Importantly, the research reveals the interwoven nature of the five TAPIC dimensions of governance and the need to engage with the complexity and relationality of health system reform processes. Conclusions Large scale health system reform is a complex process and its governance presents distinct challenges and opportunities for stakeholders. To understand and be able to address these, and to move beyond formulaic prescriptions, critical analysis of the historical context surrounding the policy reform and the institutional relationships at its core are needed.