Healthcare managers of the future will need to be prepared to accept greater accountability for the quality and efficiency of healthcare. National and state scorecards on health system performance indicate wide variation across the U.S. and across hospitals and health systems on key dimensions of performance including health outcomes, quality, access, equity, and efficiency. Benchmark data on achievable performance will be useful to healthcare managers in identifying best practices, setting priorities for improvement, and closing gaps in performance. Payment reforms are likely to reward healthcare organizations that serve as patient-centered medical homes, or assume accountability for total acute care, including hospital readmissions and post-hospital care. Health reforms to extend affordable health insurance to all, align financial incentives to enhance value and achieve savings, organize the healthcare system around the patient to ensure that care is accessible and coordinated, assist providers in meeting and raising benchmarks for high-quality, efficient care, and support greater public-private collaboration are needed to set the U.S. health system on a path to high performance.