November 12, 2019, Vol 322, No. 18, Pages 1731-1836

This Viewpoint discusses the importance of expanding accountability in quality-based payment reform from clinicians alone to include health systems and patients to align financial incentives for improving health outcomes among all the elements that contribute to the cost and enjoy the benefits of achieving them.

In this Viewpoint, Milton Packer and colleagues argue that reliance on a threshold of LVEF ≤40% to define heart failure with reduced ejection fraction (HFrEF) may exclude patients with impaired systolic function and subnormal LVEF from evidence-based treatments that reduce morbidity and mortality, and the authors propose that the LVEF threshold for HFrEF treatment be increased to ≤50%.

This Viewpoint summarizes a 2019 National Academies of Sciences, Engineering, and Medicine consensus committee report defining 5 priority development areas for the US health care system to integrate social care into health care delivery: designing delivery systems and building workforce, developing digital infrastructure interoperable between health and social care organizations, and funding the integration and research into the effectiveness and implementation of social care practices in health care settings.

This Viewpoint proposes a template for thinking about physician malpractice liability arising from use of artificial intelligence (AI) in clinical practice, and identifies scenarios with and without injury and liability vs based on alignment of AI recommendations with standards of care, AI accuracy, and physician decisions in response.