Joel V. Brill, MD

In America, we assume that we get what we pay for, whether it be food, clothing or healthcare. Given that healthcare consumes 16% of the Gross Domestic Product and we spend more per capita than any other nation on cutting-edge care, we expect improved outcomes and more bang for the buck. However, these expenditures do not rank the United States first, second or even third in terms of life expectancy, infant mortality, immunization, cancer screening and the like.

Pay for performance (P4P) is touted as the magic bullet du jour for our healthcare cost concerns. In mid-2005, CMS released its "Quality Roadmap" aimed at delivering "the right care for every person every time." Consistent with this initiative, CMS has published quality measurements and information directed toward the beneficiary, the provider and, ultimately, the purchaser audiences.

Advanced specialty pharmaceuticals are increasingly used to treat a wide range of conditions. They require close clinical monitoring. With a relatively short shelf life and limited stability, they call for special handling and timely distribution.

Heal thcare is in desperate need of disruption. Much of our nation's innovation spending is directed at the most complex, challenging and sophisticated problems in healthcare. Much less is being spent on learning how to provide the healthcare that most of us need, most of the time, in a way that is simpler, more convenient and less costly.

There also needs to be sufficient access and guidance so the beneficiary can make informed and knowledgeable choices.