It’s clear that the U.S. health care system is in need of significant change. Despite modest successes in “bending the cost curve,” health care spending is expected to expand from 17 to 19 percent of GDP in less than a decade1, 2, 3. What’s worse is that we’re generally not getting our money’s worth. According to a 2014 study from the Commonwealth Fund of 11 developed countries, the United States ranks last in overall care quality, while spending about twice as much per capita as high-ranking countries like the United Kingdom, Sweden and Australia4.

In response to soaring costs and lagging quality, payers now are actively looking to deliver better outcomes at lower cost. This includes shifting risk to providers through alternative payment models and limiting access to, as well as reimbursement for, products and services that don’t show sufficient economic and clinical value.

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