With healthcare costs escalating out of control, additional strategies are needed to propel reform. Three major strategies are explored revolving around pathways, patients, and processes. First, while not a stand-alone solution for improving healthcare, clinical pathways provide a quality and process benchmark of previously unavailable breadth, depth, and specificity that can be leveraged by additional strategies. Pathways enable data collection, decision support, and clinical summaries that can improve communication, facilitate coordination, and enable outcome feedback, Secondly, sharing decision-making with patients improves patient satisfaction, limits care regrets, and seems to reduce futile utilization and better manage the intensity of care. Finally, a variety of other recommendations to achieve cost-effectiveness emphasize interventions that provide the greatest value (efficiency per unit cost), align incentives, and minimize administrative costs. A final recommendation for managing health care risk involves a new paradigm for partnership to leverage mutual core competencies between payers and providers. If provider organizations developed comprehensive clinical pathways annotated with outcomes and costs, payer actuaries could use this information to more accurately forecast health risk and design health plan tiers in a way that maximizes outcomes and value for a variety of health plan funding levels.