This year’s tumultuous campaign season has been riveting. However, Election Day will soon come and go, and our attention will turn from debates and proposals to the actual policy actions of our newly elected executive and legislative leaders. 

Health care, which will likely soon approach nearly 20 percent of gross domestic product, will undoubtedly be among the top policy concerns for our new administration and Congress. The critical question will be how our leaders understand this complex topic and prioritize the directions our country should take. The question is relevant for all of us—health systems leaders, clinicians, advocates, consumers, and philanthropy.

Will we, for example, acknowledge and prepare for the 10,000 baby boomers who turn 65 every day and who are living longer than ever before? (A tremendous success story for humanity, by the way.) Will we focus attention in the right way on the 5 percent of people whose care accounts for 50 percent of costs because of their complex health and social needs?

These are the pressing questions that The John A. Hartford Foundation and I believe must be at the top of the national health care agenda.

Fortunately, through its Vital Directions for Health and Health Care Initiative, the National Academy of Medicine has organized a group of more than 100 renowned scholars, scientists, and policymakers from across the country who share these and similar concerns. Through a set of 19 peer-reviewed papers, they have presented an actionable set of evidence-based recommendations, organized in priority areas of opportunity in health and health care, recommendations that our newly elected leaders and others can follow as a guide. This work is meant to yield timely progress toward three overarching goals for the United States: 1) better health and well-being; 2) high-value health care; and 3) strong science and technology.

I was honored to be among these authors, who were guided by an esteemed 18-member steering committee. The Journal of the American Medical Association published these papers online this week and they are available for free on the NAM website. A symposium will be held on September 26 in Washington, DC. The event will invite reaction and feedback from stakeholders in order to create an overarching synthesis paper later this year.

In “Preparing for Better Health and Health Care for an Aging Population,” I had the privilege of collaborating with my long-time friend and mentor Jack Rowe, along with Lisa Berkman, Linda Fried, James Jackson, and Jay Olshansky in discussing our rapidly aging nation and the need for better preparation. The paper focuses on four specific recommendations:


  1. We must develop and spread effective models of care delivery for older adults;
  2. We need to augment the eldercare workforce, both in terms of numbers and competence;
  3. We should promote social supports and engagement for older people; and
  4. We need more high-quality care and dignity for those near or at the end of life.

Led by my colleague David Blumenthal of the Commonwealth Fund, Gerry Anderson, Sheila Burke, Ashish Jha, Peter Long and I also authored, “Tailoring Complex-Care Management, Coordination, and Integration for High-Need, High-Cost Patients.” In it, we address the pressing need for a new paradigm in the organization, financing, and delivery of health care services for the small proportion of people in this country who have the highest medical and social needs, and therefore the highest health care costs.

Our recommendations include strengthening value-based payment design, increasing flexibility to pay for “non-medical” services, and prioritizing health-information exchange.


As the Vital Directions introductory article from Victor Djau, Mark McClellan, and J. Michael McGinnis states, we are at a time of “unparalleled dynamism for policy and practice” with tremendous advances in medical science and care delivery that create tremendous opportunities for us. However, our current health care system faces critical challenges. As the authors note, “…1 in 10 U.S. residents rate their health as poor or only fair, and overall life expectancy and care quality continue to lag behind other high-income nations. Care decisions frequently do not align with patient goals or evidence of effectiveness, driving unnecessary spending and diminishing the value of health care.”

These are complex challenges that require thoughtful policy solutions. I am hopeful that the National Academy of Medicine’s Vital Directions Initiative will provide a platform on which our next administration and elected leaders, along with all of us, can build to improve care for older adults and our entire nation.