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about five years ago um dartmouth college my colleagues here at dartmouth and i and others had come up with a pretty clear set of diagnoses of what ale whatamp;#39;s the what are the underlying causes of the ills of the us health care system inadequate information so we needed much better information about what worked and didnamp;#39;t and information that would engage patients the second underlying problem with the healthcare system that we recognized was the remarkable fragmentation and care that is experienced by patients multiple specialists if youamp;#39;re sick multiple physicians multiple institutions all failing to coordinate care for an individual patient especially once a patient was sick once a patient had a chronic illness and and the third problem was we have a payment system that rewards reinforces that fragmentation and rewards more care not necessarily better care so with those diagnoses in hand working with mark mcclellan and others mark mcclellan was the fo
