Kaiser Permanente, the Mayo Clinic and Intermountain Health Care, three health systems known for their emphasis on primary care, care coordination and integrated delivery systems, have collaborated on a five-year vision for improving how we deliver health care. The paper outlines practical steps that would move us from a fragmented, inefficient, and expensive system to one based on teamwork, care coordination and sound medical evidence to guide clinical decision-making. The five-year plan is built around an expanded health information technology infrastructure and an ambitious set of pilot programs, drawing in Medicare, other public programs and private insurers, that would lead us to a system where we pay for good value, and good quality. Hallmarks would include:

• Care coordination and teamwork, particularly for people suffering from multiple chronic diseases.
• More primary care
• Shared decision making, where patients would make informed choices, knowing their full range of options and likely outcomes
• Shared responsibility. Doctors would get paid for value, not volume, but patients would also get support in making healthy lifestyle and wellness choices.
• Patient-centered use of information technology
• Evidence-based care (requiring more federally backed comparative effectiveness research)
• Payment reform so that providers get paid based on value (safety, quality, patient satisfaction)
• Professional liability reform to create a culture of safety and communication

The five-year timeline starts with careful planning and expanded research for the pilot programs, allows time for evaluation and adjustment, and culminates in a shift to new payment systems.

These ideas aren't all brand new, but they've been pulled together into a useful roadmap. It's particularly encouraging to see them coming from innovative health care providers and practitioners who are already doing many of these things, not just policy experts theorizing about how to achieve safe, quality, patient-centered care. Other providers have much to learn from their example.