	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 second challenge is to eradicate disparities in care. 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 embraced 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 health information technology, 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 Health Information Technology for Economic and Clinical Health (HITECH) Act, which is intended to promote the widespread adoption of health information technology (HIT) for the electronic sharing of clinical data among hospitals, physicians, and other health care stakeholders. Overview of Report

On September 17, 2009, Senator Harkin introduced a comprehensive health care reform bill entitled the Affordable Health Choices Act ( S. 1679 ). Title II includes provisions related to improving health care quality and service delivery, including strengthening quality measurement. Title III promotes preventive services. Title IV includes provisions to increase the primary care and public health workforce. Title V includes a series of provisions intended to prevent health care fraud and abuse. This report summarizes the workforce, quality, prevention, and other provisions in Titles I, II, III, IV, and VI of the Senate HELP bill, as amended and adopted by the HELP Committee. This report will be updated to reflect future legislative actions. A companion report, CRS Report R40745, Public Health, Workforce, Quality, and Other Provisions in H.R. 3200 , summarizes comparable provisions in the House health reform legislation, American's Affordable Health Choices Act of 2009 ( H.R. 3200 ). This legislation was jointly developed by the House Committees on Ways and Means, Energy and Commerce, and Education and Labor, which share jurisdiction over the federal health statutes.
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 embraced 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, and, most importantly, the alignment of payment incentives with high-quality care.
Congress took an important first 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 health information technology (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. America's Affordable Health Choices Act of 2009 (H.R. 3200), introduced in the House and approved by the Committees on Ways and Means, Energy and Commerce, and Education and Labor, includes numerous provisions intended to increase the primary care and public health workforce, promote preventive services, and strengthen quality measurement, among other things. In the Senate, the Health, Education, Labor, and Pensions (HELP) Committee has approved the Affordable Health Choices Act (S. 1679), which addresses health care delivery reform issues such as expanding private health insurance coverage, improving health care quality and strengthening quality measurement, encouraging preventive services, expanding the health care workforce, preventing health care fraud and abuse, and improving access to medical therapies. This report summarizes the workforce, quality, prevention, and other selected provisions in S. 1679, as amended and adopted by the Senate HELP Committee. It will be updated to reflect future legislative actions. A companion product, CRS Report R40745, Public Health, Workforce, Quality, and Other Provisions in H.R. 3200, summarizes comparable provisions in the House health reform legislation, American's Affordable Health Choices Act of 2009 (H.R. 3200).