This article presents eight recommendations to improve quality and lower costs of the U.S. health care system. The recommendations were created by the FRESH-thinking project, a series of workshops attended by physicians, health insurance executives, business leaders, economists, health policy experts, and hospital administrators.


  1. Replace the current payment system with one that rewards efficient delivery of health care and that bases payment on measured outcomes.
  2. Establish an independent agency to assess the comparative effectiveness of drugs and medical treatments.
  3. Simplify health care laws and regulations at the federal and state level to promote innovation, streamline administration and support coordination.
  4. Create a national, interoperable technology infrastructure.
  5. Develop a national health database with participation from all owners of health care data.
  6. Identify revenue sources, including a cap on the tax exemption for employer-sponsored insurance, to expand health care coverage to all Americans.
  7. Develop regional insurance exchanges to pool risk and provide standard benefit packages to all Americans without employer-based health insurance.
  8. Monitor the regional exchanges with a board of stakeholders to determine and update the standard benefit package offered by the exchanges.