	Introduction

Health care reform is at the top of the domestic policy agenda for the 111 th Congress, driven by concerns about the growing ranks of the uninsured and the unsustainable growth in spending on health care and health insurance. Improving access to care and controlling rising costs will require changes to both the financing and delivery of health care. Experts point to a growing body of evidence of the health care system's failure to consistently provide high-quality care to all Americans. The first is to improve patient safety by eliminating medical errors and other adverse events. The final challenge is to eliminate unnecessary and ineffective care that compromises quality, drives up costs, and neglects the needs of patients. Health Care Delivery Reform

While primarily focused on health care financing issues, the health reform debate has generated a number of proposals to address these challenges and improve the delivery of health care services. They include initiatives to encourage individuals to adopt healthier lifestyles, and to change the way that physicians and other providers treat and manage disease. Delivery reform proposals focus on (1) expanding the primary care workforce, (2) encouraging the use of clinical preventive services, and (3) strengthening the role of chronic care management. Drivers of Reform

Health care delivery reform cannot happen unless mechanisms are in place to drive change in the systems of care. Key drivers include performance measurement and the public dissemination of performance information, comparative effectiveness research, adoption of HIT, and, perhaps most importantly, alignment of payment incentives with high-quality care. American Recovery and Reinvestment Act

Congress took one step toward reforming the health care delivery system when it enacted the American Recovery and Reinvestment Act (ARRA; P.L. 111-5 ) in February 2009. It also established an interagency advisory panel to help coordinate and support the research. In addition, ARRA incorporated the HITECH Act, which is intended to promote the widespread adoption of HIT for the electronic sharing of clinical data among hospitals, physicians, and other health care stakeholders. Overview of Report

On October 19, 2009, Senator Max Baucus introduced a comprehensive health care reform bill entitled the America's Healthy Future Act of 2009 ( S. 1796 , S.Rept. 111-89 ). The legislation is based on the Chairman's Mark which was ordered reported, as amended, by the Senate Finance Committee on October 13, 2009. The report groups the bill's provisions under the following headings: (1) health workforce; (2) health care quality; (3) health information technology; (4) prevention and wellness; (5) maternal and child health services; (6) health disparities; (7) emergency care; (8) health care for veterans; (9) elder justice; and (10) miscellaneous. A companion report, CRS Report R40831, Public Health, Workforce, Quality, and Other Provisions in the Affordable Health Choices Act (S. 1679) , summarizes comparable provisions in the Senate HELP Committee's health reform legislation, the Affordable Health Choices Act ( S. 1679 ). The Secretary would be required to report the results of such a study to the House Committee on Ways and Means and the Senate Finance Committee. 2006 ) was introduced in the House by Representative Peter T. King.
Health care reform is at the top of the domestic policy agenda for the 111th Congress, driven by concerns about the growing ranks of the uninsured and the unsustainable growth in spending on health care and health insurance. But efforts to improve access to care and control rising health care costs also will require changes to the health care delivery system. Experts point to a growing body of evidence of the health care system's failure to consistently provide high-quality care to all Americans. Major challenges to the delivery of high-quality care include improving patient safety by eliminating medical errors, eradicating disparities in care, reducing the burden of chronic disease, and eliminating unnecessary and ineffective care that compromises quality, drives up costs, and neglects the needs of patients.
The health reform debate has generated a number of proposals to address these challenges and improve the delivery of health care services. They include initiatives to encourage individuals to adopt healthier lifestyles, and to change the way that physicians and other providers treat and manage disease. Delivery reform proposals focus on expanding the primary care workforce, encouraging the use of clinical preventive services, and strengthening the role of chronic care management. However, health care delivery reform cannot happen unless mechanisms are in place to drive change in the systems of care. Key drivers include performance measurement and the public dissemination of performance information, comparative effectiveness research, adoption of health information technology (HIT), and, most importantly, the alignment of payment incentives with high-quality care.
Congress took an important step toward reforming the health care delivery system when it enacted the American Recovery and Reinvestment Act (ARRA; P.L. 111-5) in February 2009. ARRA included $1.1 billion for comparative effectiveness research and established an interagency advisory panel to help coordinate and support the research. It also incorporated the Health Information Technology for Economic and Clinical Health (HITECH) Act, which is intended to promote the widespread adoption of HIT for the electronic sharing of clinical data among hospitals, physicians, and other health care stakeholders.
Both the House and the Senate are now considering health reform legislation. On October 19, 2009, Senator Max Baucus introduced a comprehensive health care reform bill entitled the America's Healthy Future Act of 2009 (S. 1796, S.Rept. 111-89). The legislation is based on the Chairman's Mark that was ordered reported, as amended, by the Senate Finance Committee on October 13, 2009. This report summarizes the workforce, quality, prevention, and other selected provisions, including those related to elder justice, maternal and child health, and health care for veterans, in S. 1796. The Senate Health, Education, Labor, and Pensions (HELP) Committee approved the Affordable Health Choices Act (S. 1679), which addresses health care delivery reform issues such as expanding private health insurance coverage and expanding the health care workforce (see CRS Report R40831, Public Health, Workforce, Quality, and Other Provisions in the Affordable Health Choices Act [S. 1679]). H.R. 3962, the Affordable Health Care for America Act, was introduced in the House of Representatives on October 29, 2009. H.R. 3962 is based on H.R. 3200, America's Affordable Health Choices Act of 2009, which was originally introduced on July 14, 2009, and was reported separately on October 14, 2009, by three House committees: Education and Labor, Energy and Commerce, and Ways and Means.