In health care policy circles, "bending the cost curve down" may qualify as the phrase of the decade. More than 1 million web search references are testament to its widespread use, intended to express a focus on reducing health care costs. Yet it should not surprise anyone familiar with technocratic vocabulary that there is no clear agreement on what the phrase means. 1 Nonetheless, with health care spending nearing one-fi fth of the nation's gross domestic product, 2 the nationwide clamor to "bend the cost curve down" is understandable. In this commentary, however, we discuss the shortfalls of focusing on costs alone and instead propose a national commitment to "bending the value curve up."Although fi nding ways to control health care spending is certainly important, focusing on cost alone is neither suffi cient nor appropriate. Calling out costs in isolation may be disconcerting to many stakeholders, including those whose health care services or livelihoods rely on this important sector of the economy. For example, patients might associate cutting costs with decreased access or hastily provided care, and clinicians may fear lower salaries or undue administrative pressures. Moreover, slicing away at high-quality and lifesaving programs for the poor, the young, the disabled, or the elderly or increasing the fi nancial burden for disadvantaged populations is shortsighted and unfair. 3,4 Beyond this, focusing on cost alone ignores the benefi ts to life and well-being that result from high-quality health care spending, even if it is associated with a high price tag. Rather than simply asking whether we are spending too much, we should also ask whether we are achieving the kind of care experiences and outcomes we would expect for the price we are paying.Value is the quality of an output divided by the cost to achieve it. The numerator of the value ratio can be defi ned by using the 6 Institute of Medicine domains of quality: safety, effectiveness, effi ciency, timeliness, patient-centeredness, and equity. 5 The denominator would be the resources consumed in terms of money, time, and labor. Applying the value ratio includes determining which outcomes should be targeted for quality and cost measures. For example, Michael Porter's value framework organizes outcomes for any given medical condition into 3 successive tiers: health status achieved or retained, process of recovery, and sustainability of health. 6 Although relevant metrics and outcomes will vary immensely across medical conditions and patient populations, it seems far more sensible to place these value-based measures at the center of the discussion about improving health care rather than a blunt attempt to cut costs regardless of outcomes.Despite $2.8 trillion spent on health care, health outcomes in the United States are not consistently good. Research has demonstrated that evidence-based care AUTHORS
