NEJM Catalyst

NEJM Catalyst Practical innovations in health care delivery:

Ideas, solutions, and case studies to improve patient care and drive value in health organizations.

Health care delivery is undergoing a major transformation around quality, cost, and access. NEJM Catalyst brings health care executives, clinician leaders, and clinicians together to share innovative ideas and practical applications for enhancing the value of health care delivery. NEJM Catalyst brings insightful articles and real-life examples from a network of top thought leaders, experts and advisors to provide:

Practical innovations in health care delivery;

Impeccable quality and impact;

Active contributions from renowned authorities, thought-leaders, and advisors;

Independent and impartial curation; and

An exchange of ideas among executives and clinicians. NEJM Catalyst is produced by NEJM Group, a division of the Massachusetts Medical Society, located in Waltham, Massachusetts.

This article examines the paradox of value-based drug pricing, wherein lifesaving pharmaceuticals are increasingly price...
12/24/2025

This article examines the paradox of value-based drug pricing, wherein lifesaving pharmaceuticals are increasingly priced based on perceived therapeutic value without regard to the development or production costs, with results that most observers would not recognize as offering value.

Although this approach appears to promise to reward innovation and align incentives, it often results in unsustainable costs for consumers, health systems, and the government — particularly in the United States, where drug prices are dramatically higher than in other wealthy nations.

This article dissects different pricing rationales and illustrates how market failures and monopolies combine with inadequate government policy to distort value-based logic into an illogical outcome.

The authors propose reforms that preserve incentives for innovation while promoting affordability, including competitive market mechanisms, regulatory oversight, and international market recognition. The goal is to align value, access, innovation, and sustainability in pharmaceutical pricing: https://nej.md/4pgG1vP

Improving patient experience is an essential element of creating high-value care. Patient experience correlates with cli...
12/23/2025

Improving patient experience is an essential element of creating high-value care. Patient experience correlates with clinical outcomes and can help patients and their families build long-term trusting relationships with health care professionals and the institution as a whole.

In this article, the authors describe a quality improvement approach to increasing patient experience scores within the Department of Family Medicine at Mayo Clinic in Arizona from January 2017 through December 2020.

A comprehensive quality improvement strategy was developed to align with conceptual models in the literature and included constructs of clinician and staff engagement, a work environment of psychological safety, and an emphasis on immediate action combined with long-term, sustained progress.

Patient experience was measured as the percentage of patients who gave a top box score (i.e., a score of 5 on a 5-point Likert scale) when asked about their likelihood to recommend the practice to others.

Using a control chart, the authors analyzed quarterly top box scores and observed steady increases that were sustained over time.

By engaging staff members and drawing on the strengths of the organization’s culture and values, the effort contributed to an improved work unit and enhanced interactions with patients and among staff.

Beyond the initial 4-year period, data through mid-2024 show patient satisfaction top box scores consistently exceeding the 90th percentile nationally: https://nej.md/4rXdXQm

The NorthStar Trauma Network (NSTN) launched an initiative in 2018 to address systemic and local hospital challenges in ...
12/23/2025

The NorthStar Trauma Network (NSTN) launched an initiative in 2018 to address systemic and local hospital challenges in the delivery of fracture care across a metropolitan area with a population of about 3 million.

This regional fracture care model has expanded, serving seven hospitals in three health systems by 2023, including five participating community hospitals with level 2 or 3 trauma care centers and one level 1 pediatric hospital, all anchored by a level 1 university teaching trauma center.

Recruitment and culture have been built around shared academic values, inclusive of investigation and education, promoting a surgeon retention rate of 100% for the first 6 years while sharing learned information and innovation that helps to drive impact in the local and larger community.

Three aspects of the NSTN model, which is part of the HealthPartners system, differentiate it from other specialty or trauma care models; these are related to staffing, mission, and access.

First, the NSTN model is designed to build trauma programs for hospitals rather than just providing call coverage; these programs are distinguished by their commitment of dedicated trauma-trained staff to network-member hospitals, which may be owned and operated by a variety of different — even competing — health systems.

Second, the NSTN is anchored by one leadership team that promotes a collective academic mission among members; this is galvanized by the activities of the NorthStar Trauma Society, a related 501(c)(3) nonprofit organization focused on research, education, and innovation.

Third, the NSTN model emphasizes subspecialist-level orthopedic trauma care (generally only seen at level 1 trauma centers) at level 2 and 3 trauma center hospitals, as well as level 1 pediatric hospitals, which expands access to care.

This documentation of the evolution and methods of the NSTN may serve as a helpful example for other metropolitan communities with hospitals and health systems that seek to improve the quality of specialty-specific trauma care, the alignment of surgeons, and growth in surgical care: https://nej.md/3MJxRyb

Preexposure prophylaxis (PrEP) for HIV prevention is a highly effective tool, but it is underutilized, and significant i...
12/22/2025

Preexposure prophylaxis (PrEP) for HIV prevention is a highly effective tool, but it is underutilized, and significant inequities exist regarding which populations are able to access PrEP.

Although most PrEP care occurs in specialty settings, such as sexual health and HIV clinics, most individuals eligible for PrEP are seen in primary care; this imbalance represents an opportunity to expand PrEP access.

NYC Health + Hospitals (NYC H+H) is a municipal health care system that provides primary and specialty care across the five boroughs of New York City. To address the gap in PrEP access within primary care, a multidisciplinary working group within NYC H+H was convened in June 2023, and it included primary care providers, nursing staff, and administrative stakeholders within primary care, virology, quality, and data and analytics.

The working group interfaced with facilities directly to listen to and engage with the care teams and patients to identify barriers and develop supports to facilitate implementing PrEP services within primary care.

In response to care team and patient needs, electronic medical record tools were developed, and customized training and patient-facing educational materials were created to address identified gaps in care team knowledge regarding PrEP care services.

Training and electronic medical record tool dissemination occurred, initially, as a proof of concept at one pilot site in East New York, Brooklyn, from June to December 2023, and resulted in a threefold increase in PrEP uptake among patients who had a documented PrEP discussion with their care team, at 20% (15/76), as compared with the NYC H+H system for PrEP uptake, at 6.8% (1207/17,724) (P

Heart failure remains a leading cause of potentially avoidable hospital admissions throughout the United States and a si...
12/22/2025

Heart failure remains a leading cause of potentially avoidable hospital admissions throughout the United States and a significant driver of unnecessary, avoidable costs within value-based care programs.

In a baseline population of 3233 hospital emergency department (ED) visits for heart failure, which occurred over 12 months ending in June 2023 across six WellSpan Health acute care hospitals, 2868 (88.7%) resulted in inpatient admissions. Among those admissions, 2535 (96.0%) were deemed potentially avoidable by the CMS Prevention Quality Indicator (PQI) 08 heart failure admission quality indicator. Collectively, these admissions totaled US$27,618,825 in potentially avoidable total costs of care.

Through process improvements that modified triaging algorithms related to heart failure exacerbations where shortness of breath or lower extremity edema were present, 92.2% of triaged patients with heart failure were managed in an ambulatory setting, with 84.7% avoiding an ED visit within 24 hours.

The 12% cost reduction goal was almost achieved just 1 year into the intervention, with an 11.2% reduction in potentially avoidable admissions (CMS PQI 08, a core quality measure) and a US$3,352,248 reduction in total costs of care.

This novel intervention executed with Lean management principles was a pragmatic process improvement that can be readily replicated by other systems to reduce unnecessary, avoidable referrals of mild to moderate heart failure exacerbations to hospital EDs: https://nej.md/48VcXDB

Hengqin Guangdong–Macao Deep Cooperation Zone: A Test Bed for Internationalizing China’s Health Care System https://nej....
12/19/2025

Hengqin Guangdong–Macao Deep Cooperation Zone: A Test Bed for Internationalizing China’s Health Care System https://nej.md/3YBFA40

In this interview, Eric Rubin, Editor-in-Chief of the New England Journal of Medicine, speaks with Dr. Jian’ an Wang, Pr...
12/19/2025

In this interview, Eric Rubin, Editor-in-Chief of the New England Journal of Medicine, speaks with Dr. Jian’ an Wang, President of The Second Affiliated Hospital at Zhejiang University School of Medicine, and Dr. Xinyang Hu, the hospital’s Executive Vice President, about patient-centered care, operational efficiency, and research integration in a major Chinese academic medical center: https://nej.md/4s34IOz

The health care field is at a critical moment. Progress on patient safety, outside some key quality measures, has stagna...
12/18/2025

The health care field is at a critical moment. Progress on patient safety, outside some key quality measures, has stagnated, and health care professionals are seeing increased calls in the literature for balancing current approaches to safety with some more future-ready ones if they are to realize the level of improvement they seek.

Yet, judging by the various action plans and structural measures put forth over the past few years or so, there is still a gap in realizing this new approach, even as an increasing number of organizations and agencies are open to the idea.

In this article, the authors discuss complexity in health care and why a transformed approach to how health care professionals advance patient safety is being called for. They also describe the experiences of two health systems in manifesting a human-centered resilience engineering approach to driving performance in the complex, adaptive field of health care.

The authors end by calling for renewed curiosity and courage from the health care safety community, and invite everyone to share and learn together as we progress toward a new approach to patient safety in health care: https://nej.md/4rW1DQF

Overcoming the Medical Insurance Trilemma: Artificial Intelligence Doctor Agent for Enhanced Osteoporosis Management: ht...
12/18/2025

Overcoming the Medical Insurance Trilemma: Artificial Intelligence Doctor Agent for Enhanced Osteoporosis Management: https://nej.md/4aFvRkL

NEJM Catalyst Insights Council members say older patients face two interconnected sets of challenges: at the patient lev...
12/18/2025

NEJM Catalyst Insights Council members say older patients face two interconnected sets of challenges: at the patient level, declining self-management ability compounded by absence of necessary social support networks; and at the health care delivery system level, insufficient care coordination compounded by lack of clinician time. Survey results are highly congruent worldwide, suggesting that no country has fully realized elder care challenges and potential improvements. Read the report: https://nej.md/4rYuQdF

The January 2026 issue of NEJM Catalyst Innovations in Care Delivery demonstrates how health care leaders and their orga...
12/17/2025

The January 2026 issue of NEJM Catalyst Innovations in Care Delivery demonstrates how health care leaders and their organizations can break through complexity. Read or listen to the letter from our editors: https://nej.md/3MCuZDq

📢 In the January 2026 issue: patient safety, complexity in health care, heart failure treatment, HIV prevention, orthope...
12/17/2025

📢 In the January 2026 issue: patient safety, complexity in health care, heart failure treatment, HIV prevention, orthopedic trauma care, patient experience scores, drug pricing, and elder care.

📖 View the issue: https://nej.md/4j0CAHN (Instagram link in bio)

🎧 From the Editors: The Keys to Overcoming Complexity in Health Care https://nej.md/3MCuZDq

👵 Insights Report: As Elder Care Needs Grow, What’s Your Organization’s Plan? https://nej.md/4rYuQdF

✅ From HRO to HRE: Human-Centered Resilience Engineering as an Evolving Framework for Patient Safety Management https://nej.md/4rW1DQF

♥ An Optimized Heart Failure Triaging Protocol to Reduce Avoidable Hospitalizations and Total Costs of Care https://nej.md/48VcXDB

💉 Improved HIV Preexposure Prophylaxis Uptake in New York City https://nej.md/4jjSYDL

🦵 The NorthStar Trauma Network: An Orthopedic Care Network across Three Health Systems https://nej.md/3MJxRyb

🤝 A Comprehensive Quality Improvement Approach to Better Patient Experience https://nej.md/4rXdXQm

💊 Reconciling the Paradox of Value-Based Drug Pricing https://nej.md/4pgG1vP

🔑 Why Clinicians Hold the Key to Fixing Health Care’s Complexity Problem https://nej.md/4iRSR1Y

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Innovations in Health Care Delivery

Health care delivery is undergoing a major transformation around quality, cost, and access. NEJM Catalyst brings health care executives, clinician leaders, and clinicians together to share innovative ideas and practical applications for enhancing the value of health care delivery.

Since December 2015, NEJM Catalyst has brought together a network of health care leaders to share insightful ideas and real-life examples of innovations in health care delivery, in the form of articles, case studies, quarterly events, and monthly surveys of our Insights Council.

NEJM Catalyst is produced by NEJM Group, a division of the Massachusetts Medical Society, located in Waltham, Massachusetts.