“Knowing is not enough; we must apply. Willing is not enough; we must do.”

—Goethe

Advising the Nation. Improving Health.

The National Academy of Sciences is a private, nonprofit, self-perpetuating society of distinguished scholars engaged in scientific and engineering research, dedicated to the furtherance of science and technology and to their use for the general welfare. Upon the authority of the charter granted to it by the Congress in 1863, the Academy has a mandate that requires it to advise the federal government on scientific and technical matters. Dr. Ralph J. Cicerone is president of the National Academy of Sciences.

The National Academy of Engineering was established in 1964, under the charter of the National Academy of Sciences, as a parallel organization of outstanding engineers. It is autonomous in its administration and in the selection of its members, sharing with the National Academy of Sciences the responsibility for advising the federal government. The National Academy of Engineering also sponsors engineering programs aimed at meeting national needs, encourages education and research, and recognizes the superior achievements of engineers. Dr. Charles M. Vest is president of the National Academy of Engineering.

The Institute of Medicine was established in 1970 by the National Academy of Sciences to secure the services of eminent members of appropriate professions in the examination of policy matters pertaining to the health of the public. The Institute acts under the responsibility given to the National Academy of Sciences by its congressional charter to be an adviser to the federal government and, upon its own initiative, to identify issues of medical care, research, and education. Dr. Harvey V. Fineberg is president of the Institute of Medicine.

The National Research Council was organized by the National Academy of Sciences in 1916 to associate the broad community of science and technology with the Academy’s purposes of furthering knowledge and advising the federal government. Functioning in accordance with general policies determined by the Academy, the Council has become the principal operating agency of both the National Academy of Sciences and the National Academy of Engineering in providing services to the government, the public, and the scientific and engineering communities. The Council is administered jointly by both Academies and the Institute of Medicine. Dr. Ralph J. Cicerone and Dr. Charles M. Vest are chair and vice chair, respectively, of the National Research Council.

www.national-academies.org

ROUNDTABLE ON VALUE & SCIENCE-DRIVEN HEALTH CARE1

Mark B. McClellan (Chair, 2011-Present), Director, Engelberg Center for Healthcare Reform, The Brookings Institution

Denis A. Cortese (Chair, 2006-2011), Emeritus President and Chief Executive Officer, Mayo Clinic; Foundation Professor, ASU

Donald Berwick, Administrator, Centers for Medicare & Medicaid Services (ex officio)

Bruce G. Bodaken, Chairman, President, and Chief Executive Officer, Blue Shield of California

David R. Brennan, Chief Executive Officer, AstraZeneca PLC

Paul Chew, Chief Science Officer and CMO, sanofi-aventis U.S., Inc. Carolyn M. Clancy, Director, Agency for Healthcare Research and Quality

(ex officio)

Michael J. Critelli, Chief Executive Officer, Dossia

Helen Darling, President, National Business Group on Health

Thomas R. Frieden, Director, Centers for Disease Control and Prevention (designee: Chesley Richards) (ex officio)

Patricia A. Gabow, Chief Executive Officer, Denver Health & Hospital Authority

Atul Gawande, General and Endocrine Surgeon, Brigham and Women’s Hospital

Gary L. Gottlieb, President and CEO, Partners HealthCare System James A. Guest, President, Consumers Union

George C. Halvorson, Chairman and Chief Executive Officer, Kaiser Permanente

Margaret A. Hamburg, Commissioner, Food and Drug Administration (ex officio)

James Heywood, Chairman, PatientsLikeMe

Carmen Hooker Odom, President, Milbank Memorial Fund

Ardis Hoven, Immediate Past Board Chair, American Medical Association Brent James, Chief Quality Officer and Executive Director, Institute for

Health Care Delivery Research, Intermountain Healthcare Michael M. E. Johns, Chancellor, Emory University

Craig Jones, Director, Vermont Blueprint for Health

Cato T. Laurencin, Director, Regenerative Engineering, University of Connecticut

Stephen P. MacMillan, President and Chief Executive Officer, Stryker

1  Formerly the Roundtable on Evidence-Based Medicine, Institute of Medicine forums and roundtables do not issue, review, or approve individual documents. The responsibility for the published workshop summary rests with the workshop rapporteurs and the institution.

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Sheri S. McCoy, Vice Chair, Executive Committee, Johnson & Johnson Farzad Mostashari, National Coordinator, Office of the National

Coordinator for Health IT (ex officio)

Elizabeth G. Nabel, President, Brigham and Women’s Hospital

Mary D. Naylor, Professor and Director of Center for Transitions in Health, University of Pennsylvania

Peter Neupert, Corporate Vice President, Health Solutions Group, Microsoft Corporation

William D. Novelli, Former CEO, AARP; Professor, Georgetown University Jonathan B. Perlin, Chief Medical Officer and President, Clinical and

Physician Services, HCA, Inc.

Robert A. Petzel, Under Secretary (Health), Department of Veterans Affairs (ex officio)

Richard Platt, Professor and Chair, Harvard Medical School and Harvard Pilgrim Health Care

John C. Rother, Group Executive Officer, AARP

John W. Rowe, Professor, Mailman School of Public Health, Columbia University

Susan Shurin, Acting Director, National Heart, Lung, and Blood Institute (ex officio)

Mark D. Smith, President and CEO, California HealthCare Foundation Glenn D. Steele, President and Chief Executive Officer, Geisinger Health

System

Reed D. Tuckson, Executive VP and Chief of Medical Affairs, UnitedHealth Group

Frances M. Visco, President, National Breast Cancer Coalition

Jonathan Woodson, Assistant Secretary for Health Affairs, Department of Defense (designee: Michael Dinneen) (ex officio)

Workshop Planning Committee2

Jay Bernhardt, Centers for Disease Control and Prevention Michael Fordis, John M. Eisenberg Center, Baylor College Michael Lauer, National Heart, Lung, and Blood Institute Joel Kupersmith, Veterans Health Administration

Murray Ross, Kaiser Foundation Health Plan

Karen Smith, AstraZeneca PLC (formerly, now with Allergan, Inc.) Myrl Weinberg, National Health Council

2  Institute of Medicine planning committees are solely responsible for organizing the workshop, identifying topics, and choosing speakers. The responsibility for the published workshop summary rests with the workshop rapporteurs and the institution.

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Roundtable Staff

Neha Agarwal, Intern (through August 2010) Christie Bell, Financial Associate

Malcolm Biles, Program Assistant (through October 2010)

Claudia Grossmann, Program Officer

J. Michael McGinnis, Senior Scholar and Executive Director LeighAnne Olsen, Program Officer (through June 2010) Brian Powers, Senior Program Assistant

Valerie Rohrbach, Program Assistant

Julia Sanders, Program Assistant

Robert Saunders, Program Officer Leigh Stuckhardt, Program Associate

Kate Vasconi, Senior Program Assistant (through January 2011) Catherine Zweig, Senior Program Assistant (through June 2010)

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Reviewers

This report has been reviewed in draft form by individuals chosen for their diverse perspectives and technical expertise, in accordance with procedures approved by the National Research Council’s Report Review Committee. The purpose of this independent review is to provide candid and critical comments that will assist the institution in making its published report as sound as possible and to ensure that the report meets institutional standards for objectivity, evidence, and responsiveness to the study charge. The review comments and draft manuscript remain confidential to protect the integrity of the deliberative process. We wish to thank the following individuals for their review of this report:

Adam M. Clark, FasterCures

Marribeth Shannon, California HealthCare Foundation

Jason Spangler, Partnership for Prevention

Myrl Weinberg, National Health Council

Although the reviewers listed above have provided many constructive comments and suggestions, they were not asked to endorse the final draft of the report before its release. The review of this report was overseen by Joseph E. Scherger, University of California, San Diego. Appointed by the National Research Council and the Institute of Medicine, he was responsible for making certain that an independent examination of this report was carried out in accordance with institutional procedures and that all review comments were carefully considered. Responsibility for the final content of this report rests entirely with the editors and the institution.

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