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Published on: February 16, 2011
Evolving Better Health Care for Every American.
Gillian Sanders Schmidler1, Patricia Green2, Marianne Hamilton Lopez3
1Professor of Population Health Sciences and Deputy Director, Duke-Margolis Institute for Health Policy, Durham, NC, USA.
NEJM Catalyst Innovations in Care Delivery
|July 15, 2026
Summary
Transforming the U.S. health system needs coordinated strategies to overcome fragmentation and high costs. This involves advancing value-based care, integrating social determinants, and modernizing infrastructure for better quality and equity.
Area of Science:
- Health policy
- Healthcare systems research
- Public health
Background:
- U.S. health system faces fragmentation, fee-for-service incentives, and underinvestment in primary care.
- These issues lead to poor outcomes and unsustainable costs, disproportionately affecting vulnerable populations.
- Lack of access to preventive and social support services exacerbates health inequities.
Purpose of the Study:
- To synthesize policy and operational strategies for advancing value-based care.
- To propose methods for integrating social determinants of health into risk adjustment.
- To outline a roadmap for modernizing health data systems and strengthening workforce resilience.
Main Methods:
- Policy synthesis
- Operational strategy analysis
- Roadmap development
Main Results:
- Identified key strategies including value-based care adoption and social determinant integration.
- Proposed modernization of data systems and enhancement of safety-net capacity.
- Outlined a sequenced roadmap with short-, intermediate-, and long-term actions.
Conclusions:
- Coordinated alignment across financing, care delivery, workforce, and innovation is crucial for health system transformation.
- Implementing proposed strategies can lead to durable improvements in health quality, equity, and cost.
- Multi-sectoral collaboration is essential for achieving a resilient and equitable health system.
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