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Redesigning metrics to integrate professionalism into the governance of health care.

Professionalism in health care encapsulates the critical elements of value that are at risk of marginalization when health care reform is governed by economics. The successful transformation of health care depends on maintaining the primacy of patient interests, high standards of competence and integrity, and the professional provision of expert guidance to society on health matters.1 The centrality of patients and the patient-physician relationship in defining outcomes and value is particularly important as payment reform accelerates with more aggressive financial penalties and rewards.2 To achieve their intended goals, the new value-based pay-for-performance metrics must be defined carefully, for both clinicians and patients. Quality and cost metrics informed by the principles of professionalism are essential to developing better definitions of value and to leading more successful value-driven transformation. Like most of health care, the quality measurement space is pathologically fragmented. With payers, accrediting agencies, professional societies, non-for-profit quality agencies, and even for-profit information brokers all