Climbing through medicine's glass ceiling.

1887 quality of care but do not substantially reduce costs among a broad array of patients.3-5 As more empirical evidence comes in, it may become easier to identify specific ways to reduce costs; for now, the possibility and scope of the savings remain unclear. One approach that might improve the cost-effectiveness of disease-management and care-coordination strategies involves more accurately targeting these efforts toward the patients who would benefit the most. Indeed, the concept of better targeting is inherent in all the options considered here, from enhanced research on treatments to the designing of financial incentives. As medicine moves toward increasingly targeted therapies, the options for shifting insurance designs in the same direction merit consideration as policymakers grapple with the serious financial challenges faced by our public and private health insurance programs.