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At the end of the chapter, the reader will be able to:


  1. Summarize major recommendations of the Institute of Medicine (IOM) regarding health care quality.

  2. Define what is meant by quality in general and health care quality in particular.

  3. Describe what is meant by “value-driven health care.”

  4. Argue the case for multiple strategies for improving health care.

  5. Explain why quality must be measured.


It was the best of times; it was the worst of times.


Charles Dickens, A Tale of Two Cities


It is a time of great transition in health care. Rapidly increasing costs for health care services, along with recognition of suboptimal quality, have forced our government and the private sector to re-examine the U.S. health care system. One could view the current challenges in health care as being the “worst of times” but one could also envision the “best of times” by identifying many opportunities for enhancing quality and value. I hope that the profession of pharmacy will eventually look back on the first decades of the 21st century as the time when pharmacists delineated their role as promoters of quality and value.


The importance of pharmaceuticals to the treatment of chronic disease received increased attention since the implementation of the Medicare Part D drug benefit. The utilization of prescription medications by the elderly increased by 12.8% after the implementation of Part D, and the Congressional Budget Office has projected that Medicare cumulative outlays on Part D medications will reach nearly $800 billion by 2015.1 Unfortunately, there is evidence that many patients experience preventable adverse medication-related events or fail to receive appropriate drug therapy due to the shortcomings of our complex and disjointed medication-use system in the United States.2–4 Researchers have estimated that for every dollar we spend on pharmaceuticals, we spend another dollar on treating the problems that stem from suboptimal medication use and therefore waste billions of dollars in health care resources every year.5 The economic value of the health care system is far from ideal.


Improving the value of the health care system will require improved quality and/or better cost control (and ideally both). The Secretary of Health and Human Services is repositioning the federal government to be a value-based purchaser of health care services. Private-sector payers have already increased their scrutiny of quality and costs and created incentives for providers to boost performance. Realigning the incentives within the private and public sectors to drive improvements in quality and reductions in inefficiency is also known as value-driven health care.


The Institute of Medicine (IOM) has also pointed out the shortcomings of the U.S. health care system and called for a redesign for our antiquated processes of care including a renewed look at processes for prescribing, dispensing, and monitoring the use of medications.6 The National Quality Forum (NQF) has also given increased attention to the ...

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