Health care spending in the U.S. keeps soaring to new heights—but that elevation doesn’t necessarily mean more people are getting the care they need. The most recent released figure from the U.S. Centers for Medicare & Medicaid Services had health spending at $5.3 trillion in 2024, up 7.2% from the previous year.
It has been estimated that 25% to 30% of that money is wasted on administrative inefficiencies, unnecessary tests and procedures, and other barriers to providing the best care possible. With patients and physicians alike feeling this strain, a new initiative aims to reshape the conversation around care delivery and hopefully cutting down on the waste.
The newly established Health Care Transformation Hub, led by Wyatt Decker, MD, executive director of the Hub and executive vice president and chief physician for value-based care at UnitedHealth Group, is designed to do two things: elevate evidence and convene expertise.
“We launched the Health Care Transformation Hub with two specific goals in mind that we feel are necessary right now in U.S. health care,” Dr. Decker said. “One is to serve as a clearing house for scientific research on care delivery models, and the second goal is to convene thought leaders.”
Together, those objectives reflect a broader ambition to accelerate the shift toward a health system that rewards prevention, coordination and affordability rather than volume alone.
UnitedHealth Group is part of the AMA Health System Member Program, which provides enterprise solutions to equip leadership, physicians and care teams with resources to help drive the future of medicine.
A clearing house for care delivery science
Research on care delivery models is being published at a rapid pace. But for many policymakers, physicians and health system leaders, keeping up with thousands of journal articles each month is unrealistic.
“The question for us is if there's thousands of research articles coming out every month, how can we highlight the ones we believe are significant?” Dr. Decker said.
The Hub’s first objective is to serve as a clearing house by sifting through that expanding body of literature and surface research that speaks directly to improving patient care.
Those themes closely align with the principles of value-based care—an approach that seeks to move the industry away from solely paying for individual services on a piecemeal basis and more towards rewarding outcomes, coordination and long-term health.
On the Hub’s website, visitors encounter concise summaries of peer-reviewed studies—often distilled into a few lines—alongside direct links to the full articles. The goal is not to replace the research but to make it more usable.
“We’ll provide one or two lines that summarize the article,” Dr. Decker said. “Then we include the link to the full article so that we’re not trying to supplant the research itself. We really want to be a conduit so people can pull up the full article, read it and come to their own conclusions.”
That approach aims to meet audiences where they are, whether they are health policy experts searching for data on utilization trends, physicians looking for practical insights that could inform care redesign, or people working adjacent to health care who want a better understanding of current research.
Convening voices across the ecosystem
The second goal is to convene thought leaders and bring together experts on important health care topics to find solutions to pressing and growing problems.
The Hub recently hosted its first thought leadership convening focused on the national shortage of primary care providers, with particular attention to physicians, nurses, nurse practitioners and physician assistants. Leaders from advocacy organizations, academic institutions and frontline care settings participated in discussions about administrative burden, cultural factors and structural barriers that shape the primary care workforce.
For Dr. Decker, who practiced emergency medicine for more than two decades, those conversations must include both national stakeholders and physicians closest to patient care.
“Both perspectives are really valuable,” he said. “Bringing together policy experts is huge. But we also brought in a few experts who are on the front line of care delivery and practice themselves.”
The Hub’s leadership believes that sustainable reform requires balancing rigorous academic research with lived clinical experience. That includes ongoing engagement with organizations such as the AMA, which participated in the primary care convening.
“We really believe that it’s through dialogue as well as scientific evidence that we can highlight challenges in health care and potential solutions that can then help move the needle,” Dr. Decker said.
Defining “transformation” in practical terms
Dr. Decker acknowledges that “transformation” is an ambitious word and can mean different things to different audiences.
“Transforming health care is kind of a mouthful,” he said. “For me personally, and for the Health Care Transformation Hub, it’s really about how do we keep what’s great about health care in the United States but deal with how we spend twice as much per person on health care as other developed countries do.”
For the Hub, transformation involves both preserving strengths—such as the physician workforce, referral centers and entrepreneurial innovation—while simultaneously addressing cost, waste and fragmentation.
“One metric is how much are we spending on health care?” Dr. Decker said. “Another is how much are you and I spending on health care? It’s one thing to worry about the national budget. It’s another thing to talk about what it’s like sitting at the kitchen table when you need to get medical care and you can’t afford it.”
The estimates suggest that 25% to 30% of health care spending may be waste underscore the urgency—and highlight a tremendous opportunity.
“How can we drive out the waste in U.S. health care?” he said. “If 25% of it is unnecessary, that’s a massive savings that could get us back on track.”
Yet financial metrics alone are insufficient. The Hub’s longer-term vision centers on redesigning incentives so that health plans, physicians, hospitals and other stakeholders are rewarded for keeping people healthy, not just treating them when they are sick.
“Success in 12 months looks like increased awareness that we can do things differently and better in the U.S. in health care delivery,” Dr. Decker said. “Three, five, 10 years, it’s actually redesigning the health care delivery system and how we incentivize financially, we reward insurers, providers, doctors, hospitals, so that they’re actually doing the things that patients want, which is keeping them healthy and well, but having their back if they get really sick.”
Evidence on value-based care
Much of the Hub’s early research focus examines how different care delivery models influence utilization and outcomes.
Under the leadership of Kenneth Cohen, MD, chief medical officer of Optum Health and chief scientific officer of the Health Care Transformation Hub, the Hub is studying how value-based arrangements compare with traditional fee-for-service models across large patient populations.
“We’re looking at which care delivery models out there are doing a good job at identifying chronic diseases and keeping people healthy and well through things like fewer ER visits,” Dr. Decker said.
He pointed to data showing that certain value-based models are associated with 12% to 20% lower emergency department visits and similar reductions in hospitalizations. For patients with chronic conditions such as COPD, reductions in emergency department visits can be as high as 44%.
Those findings, he noted, reflect more than cost containment.
“Most of us would prefer not to be in an ER for six hours or not to be in a hospital for three days or five days,” Dr. Decker said.
In collaborative studies involving millions of patients, researchers have observed patterns that include fewer unplanned hospitalizations, improved care coordination, and in some cases more frequent—but more targeted—primary care visits alongside fewer unnecessary specialty visits.
“Most specialists welcome this,” Dr. Decker said. “Most of their professional reward comes from seeing those challenging cases that really need their help.”
By publishing and synthesizing this research, the Hub hopes to equip physicians and policymakers with clearer evidence about what models appear to improve health span—years lived in good health—while also supporting affordability and access.
Learn more with the AMA about value-based care, including ways to improve data sharing and best practices for payment methods.
Building credibility and transparency
Given the scale and complexity of U.S. health care, credibility is central to the Hub’s mission.
The Hub is also establishing an external advisory board composed of accomplished health policy leaders to help guide topic selection and research curation.
“These are accomplished health policy thought leaders who can help guide us on which articles to highlight and which important topics to bring leaders together on,” he said.
By linking directly to original journal publications, the Hub ensures that readers can review funding sources, methodologies and limitations independently.
“We are very comfortable sharing that,” Dr. Decker said of the Hub’s affiliation. “Our mission is really around U.S. health care and how we drive solutions that make health care more accessible and more affordable for people.”
From insight to action
Publishing research summaries and hosting convenings are starting points. The longer-term challenge is translating evidence into workflows that improve care without adding burdens for physicians.
The Hub’s leaders argue that change must be practical, not theoretical.
“We have to think of different ways of getting people to that outcome that we’re trying to achieve,” Dr. Decker said. “It’s not going to look the same way for everyone.”
For him, the common thread is upstream care—intervening earlier in chronic disease, aligning incentives around prevention and coordinating services so that patients are supported before crises occur.
In the near term, the Hub’s success will be measured by awareness: Are more leaders engaging with evidence about care delivery reform? Are stakeholders participating in structured dialogues about workforce shortages and administrative simplification?
Over the next several years, the benchmark becomes more ambitious: Are care delivery and payment models, regulatory frameworks and operational practices shifting in ways that keep patients healthier and reduce financial strain?
For Dr. Decker, the stakes are clear.
“It’s really about putting people first, putting the patient at the center of everything we do in health care,” he said.
If the Health Care Transformation Hub succeeds, it will not simply generate more discussion about reform. It will help ensure that the best ideas—grounded in evidence and informed by frontline experience—gain traction in a system ready for change.
