As US health care continues down the path of delivery system transformation, January’s Health Affairs explores areas of opportunities and challenges to achieving better health and better care at lower costs. Other articles focus on a range of topics of interest, including the length of time physicians spend with active and unresolved malpractice claims against them.

Seth Seabury at the RAND Corporation and coauthors report that the average physician spends almost 11 percent of his or her career with an open and unresolved medical malpractice claim. A major contributor is the length of the process of adjudicating such claims: The typical medical malpractice claim isn’t filed until almost two years after the incident occurred, and it isn’t resolved until 43 months post incident. When dealing with open claims, physicians spend up to 70 percent of that time with claims that never result in a payment.

Among the various distressing factors involved in this type of adjudication, patients and physicians alike may be more troubled by the length of time of the process than the potential damages, the authors say. They recommend exploring policy solutions that can decrease the time to resolution, including tort reform and alternative dispute management tools that can expedite the process and help limit meritless claims.

Articles addressing areas of promise for transforming the delivery of health care include:

Primary Care Physician Shortages Could Be Eliminated Through Use Of Teams, Nonphysicians, And Electronic Communications, Linda V. Green at the Columbia Business School and coauthors

Nurse Practitioner–Staffed Clinic At Virginia Mason Improves Care And Lowers Costs For Women With Benign Breast Conditions, C. Craig Blackmore at the Center for Health Services Research, Virginia Mason Medical Center, in Seattle, Washington, and coauthors

US Spending On Complementary And Alternative Medicine In 2002–08 Plateaued, Suggesting Role In Reformed Health System, Matthew A. Davis at the Dartmouth Institute for Health Policy and Clinical Practice and coauthors

San Franciscos Pay Or PlayEmployer Mandate Expanded Private Coverage By Local Firms And A Public Care Program, Carrie H. Colla at the Dartmouth Institute for Health Policy and Clinical Practice and coauthors

Mobile Clinic In Massachusetts Associated With Cost Savings From Lowering Blood Pressure And Emergency Department Use, Zirui Song at Harvard Medical School and coauthors

Articles highlighting continued hurdles in reforming care delivery include:

Small Physician Practices In New York Needed Sustained Help To Realize Gains In Quality From Use Of Electronic Health Records, Andrew M. Ryan at the Weill Cornell Medical College and coauthors

What It Will Take To Achieve The As-Yet-Unfulfilled Promises Of Health Information Technology, Arthur L. Kellermann at the RAND Corporation and Spencer Jones at the Harvard Medical School and RAND

Slow Progress On Meeting Hospital Safety Standards: Learning From The Leapfrog Group’s Efforts, John Moran and Dennis Scanlon at the Pennsylvania State University

The Experience Of Massachusetts Shows That Consumers Will Need Help In Navigating Insurance Exchanges, Anna D. Sinaiko at the Harvard School of Public Health