U.S. healthcare costs more per person than any other wealthy nation, yet outcomes lag behind on measures like life expectancy, maternal mortality, and chronic disease management. The good news: several proven strategies are already producing measurable results in parts of the system. Scaling them nationally would meaningfully improve care quality, affordability, and access.
Shifting From Fee-for-Service to Value-Based Care
The traditional payment model in American medicine rewards volume. Doctors and hospitals get paid for each test, visit, and procedure they perform, regardless of whether the patient actually gets healthier. Value-based care flips this by tying payment to outcomes: keeping patients well, managing chronic conditions effectively, and avoiding unnecessary hospital stays.
The clearest proof this works comes from Medicare’s Shared Savings Program, which groups doctors and hospitals into Accountable Care Organizations (ACOs) responsible for a defined population of patients. In 2024, the program hit its best results since launching over a decade ago. Out of 476 ACOs covering 10.3 million patients, 75% earned performance payments for keeping costs below benchmarks while maintaining or improving quality. Medicare saved $2.5 billion relative to projected spending, with net savings of $245 per patient, up from $207 the year before.
The quality improvements were just as notable. The share of ACO patients with adequately controlled high blood pressure rose to nearly 80%. The percentage of patients with poorly managed diabetes dropped. Depression screening with a documented follow-up plan jumped from about 44% to 55% in a single year. ACOs also outperformed comparable physician groups that aren’t in the program, with better blood pressure control and significantly higher rates of depression screening.
One striking finding: ACOs built primarily around primary care clinicians generated $403 in net savings per patient, nearly double the $224 from ACOs with fewer primary care doctors. That points to a broader lesson. Investing in primary care, where conditions are caught early and managed consistently, produces better results than a system oriented around specialists and hospitals.
Making Drug Prices More Transparent and Competitive
Prescription drugs are one of the most visible pain points for American patients. The U.S. pays far more for brand-name medications than other countries, partly because Medicare was historically barred from negotiating prices directly with manufacturers.
That changed with the Inflation Reduction Act, which authorized Medicare to negotiate prices on its most expensive drugs for the first time. The first round targeted ten widely used medications: the blood thinners Eliquis and Xarelto, the diabetes drugs Jardiance, Januvia, and Farxiga, the heart failure drug Entresto, the arthritis drugs Enbrel and Stelara, the cancer drug Imbruvica, and the insulin products NovoLog and Fiasp. Negotiated prices for these drugs take effect in 2026.
Ten drugs is a starting point, not a finish line. Expanding negotiation to more medications, accelerating generic competition, and capping out-of-pocket costs for patients with chronic conditions are all extensions of this approach that would lower what Americans pay at the pharmacy counter.
Cutting Administrative Waste
A significant portion of every healthcare dollar in the U.S. never touches a patient. It goes to billing, insurance paperwork, prior authorizations, coding, and compliance. The U.S. has long spent a larger share of its health budget on administration than peer countries, and that gap has only widened as the system has grown more complex. Estimates vary, but administrative spending consistently ranks among the largest categories of waste in American healthcare.
The practical consequences hit both patients and providers. Doctors spend hours each week on paperwork that doesn’t improve care. Prior authorization delays can postpone treatments by days or weeks. Patients receive surprise bills because pricing information was inaccessible or incomprehensible. Simplifying insurance billing, standardizing electronic transactions, and reducing the prior authorization burden would free up time and money for actual care delivery.
Enforcing Hospital Price Transparency
Since 2021, federal rules have required hospitals to publish their prices in machine-readable files so patients, employers, and insurers can compare costs. The idea is straightforward: when prices are visible, competition drives them down. But compliance has been slow. A 2024 audit by the HHS Office of Inspector General found that an estimated 46% of the roughly 5,900 hospitals required to follow the rule had not fully complied. Among a sample of 100 hospitals, 34 failed to publish the required comprehensive pricing files.
Stronger enforcement, including meaningful financial penalties for noncompliance, would accelerate the shift. When patients and employers can see what hospitals actually charge for common procedures, it creates pressure to bring outlier prices in line.
Building a Connected Digital Health System
One of the most frustrating aspects of American healthcare is how disconnected it is. Your primary care doctor, specialist, hospital, and pharmacy often use different electronic systems that don’t communicate with each other. That means duplicate tests, lost records, and gaps in care, especially when you move or switch providers.
A national framework called TEFCA (Trusted Exchange Framework and Common Agreement) is working to fix this by creating a network of networks for health data exchange. In December 2023, the first Qualified Health Information Networks were designated, and health data began flowing between them within days. Organizations that want to join this backbone network go through a rigorous process that typically takes about 12 months.
Full interoperability, where any provider can securely access your complete health record with your permission, would reduce medical errors, eliminate redundant testing, and give doctors a clearer picture of your health history. It would also make it far easier to coordinate care for patients with multiple chronic conditions, who account for a disproportionate share of healthcare spending.
Addressing Social Factors That Drive Health Outcomes
Clinical care accounts for only a fraction of what determines how healthy someone is. Housing instability, food insecurity, lack of transportation, unemployment, and low literacy all shape health outcomes in ways that no amount of hospital care can fully offset. A patient discharged after a heart attack who can’t afford healthy food or a safe place to recover is far more likely to end up back in the hospital.
The healthcare system is slowly building infrastructure to identify and act on these factors. Standardized codes now exist for clinicians to document social needs like housing problems, food insecurity, employment issues, and lack of transportation directly in a patient’s medical record. These codes cover everything from education and literacy barriers to problems in the family environment. The challenge is that most clinical settings still don’t use them routinely, which means social needs go unrecorded and unaddressed.
Integrating social services with healthcare delivery, so that a clinic visit can connect a patient with housing assistance or a food program, is one of the highest-leverage improvements the system could make. ACOs and community health centers that have done this report better outcomes and lower costs, because they’re treating the root causes of poor health rather than just the symptoms.
Reducing Maternal Mortality
The U.S. has the highest maternal mortality rate among wealthy nations, a gap that has persisted for years. In 2024, 649 women died of maternal causes, a rate of 17.9 deaths per 100,000 live births. That rate hasn’t improved significantly from the 18.6 recorded in 2023, and it remains far above what countries with comparable resources achieve.
The solutions aren’t mysterious. Extending postpartum Medicaid coverage beyond 60 days (many states have now moved to 12 months) keeps new mothers connected to care during the highest-risk period. Expanding access to midwifery, improving training on recognizing warning signs like preeclampsia and postpartum hemorrhage, and addressing the stark racial disparities in maternal care are all evidence-based approaches. Black women in the U.S. die from pregnancy-related causes at roughly two to three times the rate of white women, a disparity driven by systemic factors that targeted policy can address.
Investing in Prevention Over Treatment
The U.S. healthcare system is overwhelmingly oriented toward treating disease after it develops, rather than preventing it. Yet prevention is where the math works best. Expanded lung cancer screening guidelines illustrate this clearly. When researchers modeled the cost of screening more people using the updated 2021 criteria (which lowered the age and smoking history thresholds), the cost worked out to about $72,564 per quality-adjusted life year gained. That’s well within the $100,000 threshold that health economists consider cost-effective, meaning the screening pays for itself in lives saved and suffering avoided.
The same logic applies across chronic disease. Better management of high blood pressure and diabetes in primary care prevents heart attacks, strokes, kidney failure, and amputations, all of which are enormously expensive to treat. Community-based programs that help people eat better, move more, and manage stress produce returns that compound over years. The barrier isn’t evidence. It’s a payment system that still rewards procedures over prevention, and a political system that struggles to invest now for payoffs that arrive years later.