In a timely commentary published in the latest issue of the Journal of the American Medical Association (JAMA)—a week after President Obama addressed a joint session of Congress regarding health care reform—University of California, Berkeley School of Public Health Dean Stephen Shortell made recommendations on how to "bend the cost curve" in order to better afford the expansion of health care coverage.

"If health care reform is to succeed this year, compromise is greatly needed to reach agreement on how to cover the increased cost of expanding health insurance for all U.S. citizens," Dean Shortell wrote.

His key recommendations include investment in prevention, financial incentives for accountable care in hospitals and doctors’ offices, and reduction of waste and fraud. Some estimates suggest implementing these and other changes could save anywhere from $540 billion to $2 trillion over the coming decade.

Dean Shortell stressed the importance of disease prevention initiatives aimed at improving nutrition and physical activity because "they have the largest influence on reducing the future burden of disease, particularly in regard to obesity, diabetes, heart disease and cancer." There is evidence that investment in physical activity, nutrition, and smoking cessation yields a fivefold greater return in cost savings. The dean commended current health reform proposals that would allocate $10 billion for a Prevention and Wellness Fund as "a major step toward slowing the annual increase in health care spending over time, given the current evidence on return on investment."

In order to change hospital and physician behavior, Dean Shortell believes new financial incentives are needed, as well as the establishment of accountability for both cost and quality of care through performance measures and public reporting. Part of this reform would include establishing Accountable Care Organizations—under which doctors, hospitals and others work together to improve cost and performance and are held accountable for the results—and also a Center for Comparative Effectiveness that would provide hospitals and physicians with reliable and accessible data on the efficacy, effectiveness, and cost of new treatments, technologies and interventions."

Dean Shortell warned that, unlike previous efforts at health care reform, the status of health care today is such that maintaining the status quo is not in any stakeholder’s best interest. He said, "It is certain that failure to act now to reform the health insurance and health care delivery system will keep the United States on the path of ever-escalating costs and increasing numbers of uninsured persons, while offering the poorest value for the money invested among nearly all nations in the world."