Incentives. Incentives should direct attention and rewards to outcomes, quality, and cost. Roundtable participants said that the rewards and incentives prevalent in the American healthcare system were poorly aligned to effectiveness and efficiency. They discussed how the current system encouraged care that was procedure and specialty intensive—discouraging primary care and prevention.
Limits. Value may be inversely related to the level of system fragmentation. Participants suggested that moving to value driven healthcare will require "broad organizational, financial, and cultural changes" that are not likely to be attainable with the current level of fragmentation in healthcare decision making.
Communication. System level value improvement requires more seamless communication among participants. The roundtable participants noted the existence of "significant communication gaps" among individuals involved in the care delivery process.
For instance, patients and providers were determined not to communicate well with each other about diagnosis and treatment options or cost implications. This is in part, they said, because of "complex administrative and rapidly changing knowledge environments" where necessary information was not readily available to either party.
Communication—by either voice or electronic means—was often "virtually absent" among multiple providers and provider systems for a single patient. This increased the prospect of service gaps, duplications, confusion, and harm, according to the participants. Also, communication among the many groups involved in developing evidence—and the practitioners applying it—was often "unstructured and may be conflicting."