Speeding up delivery system transformation could trim upward of $2 trillion in health care spending between 2014 and 2023, according to a plan issued last month by the Commonwealth Fund Commission on a High Performance Health System. So, how would the commission get there? An ambitious 10-point plan:

Payment reforms to accelerate delivery system innovation.
[ Savings: $1.33 trillion ]

  • Pay for value: replace physician fee schedule with payment incentives to improve care.
  • Strengthen patient-centered primary care and support care teams.
  • Bundle hospital payments to focus on total cost and outcomes.
  • Align payment incentives across public and private payers.

Expand and encourage high-value choices by consumers.
[ Savings: $189 billion ]

  • Offer Medicare beneficiaries a "Medicare Essential" plan that provides more comprehensive benefits and better protection against catastrophic costs; include provider and enrollee incentives to achieve better care, better health and lower costs.
  • Provide incentives for Medicare and Medicaid beneficiaries to seek care from high-value, patient-centered medical homes, care teams, ACOs and integrated delivery systems.
  • Use health IT and other means to provide more information on clinical outcomes.

Systemwide actions to improve how health markets function.
[ Savings: $481 billion ]

  • Simplify and unify administrative policies and procedures.
  • Reform malpractice policies.
  • Establish a spending target across all payers, which should not exceed per capita economic growth.