Berwick: U.S. ripe for health care delivery improvements

July 1, 2011

By PAMELA SCHAEFFER

ATLANTA — "It's a difficult time for health care," said Dr. Donald Berwick, in a keynote address to the Catholic Health Assembly here.

Berwick, appointed administrator of the Centers for Medicare and Medicaid Services by President Barack Obama in 2010, described the mood of the country around health care as "conflicted, polarized, fretful, uncertain."

But increasingly, he said, those emotions are mixed with a sense of urgency, a conviction "that something must be done. We seem to be agreeing with that as a country across all boundaries of political persuasions."

The problems with American health care are well-known, Berwick said: costs are too high, value is too low. The nation is really at a juncture right now, he said, adding that when high costs hinder the nation's ability to invest in infrastructure, the easy choice is "to withhold things, leave some things out of the picture.

"It's a perfectly plausible way to cut costs, but it's not the right way. It's the wrong way," he said.

The right way — delivering more efficient, more effective and safer care, reducing waste — is harder to explain and execute, but offers far better answers, he said. "I am trying every way I can at CMS to make a case for that" — that American health care needs to move into a future in which "no person is ever harmed by health care. Not one hair."

Before his appointment to lead CMS, Berwick, a pediatrician, was president and chief executive of the Institute for Healthcare Improvement, an organization he cofounded and helped build into a national force for improving quality of health care. He is a former clinical professor of pediatrics and health care policy at Harvard Medical School and former professor of health policy and management at the Harvard School of Public Health.

Berwick said his primary goal since becoming administrator of CMS 11 months ago was to change its view of itself from an agency that operates simply as a payer to one with a much broader vision — a vision that makes CMS a partner with other health care organizations in seeking to improve the nation's health.

"From the day I arrived there, I proposed this vision of who we are: CMS is a major force and trustworthy partner for the continual improvement of health and health care for all Americans," he said.

Partnerships are crucial, Berwick said, adding praise for Catholic health care in general and Sr. Carol Keehan, DC, president and chief executive officer of CHA, in particular. "I can't think of a better partner than Catholic health care in the United States," he said. "And I can't thank Sr. Carol enough for that attitude of partnership. It's been there right along."

Berwick cited five values that will help to move U.S. health care in the right direction: eliminating silos and boundaries, moving quickly, participating in unconditional teamwork, supporting innovation and focusing on the customer.

"We have to constantly figure out how to do more with less," how to better share resources, he said.

The agency's aim is now better care for individuals, better health for the U.S. population and lower cost through improvement, Berwick said, combined with excellence in operations. Operational excellence includes attending to stewardship and being diligent about fraud and abuse, which he described as "all too common in our system."

Berwick said he is beginning to see the policy framework for health reform under the Patient Protection and Affordable Care Act as "two frameworks" or "two phases" — insurance reform and delivery system reform. Without delivery system reform, insurance reform is insufficient, he said. "We don't want to pay for doing a lot of things. We want results."

Accountable care organizations, electronic medical records and medical homes are among delivery system changes supported by health reform that will move health care in the right direction, he believes.

Berwick gave several examples of hospitals that have dramatically reduced rates of infection, complications and mortality by following procedures, including the Seton Family of Hospitals in Austin, Texas, where birth trauma rates have dropped dramatically. Berwick said the knowledge and techniques underlying those successes need to be shared and replicated.

"Defects help no one; excellence helps everyone," he said. "If it can be done somewhere, it can be done everywhere."

He called for "a new relationship of humility" in contrast to "a culture of control and distance and mistrust" and cited the optimism and dedication of Catholic health care leaders as one of the nation's greatest resources for moving forward.

And he is optimistic himself.

"We will never go back" to old attitudes about health care finance and delivery, he said. "The mentality has changed in our country. And so, in some really important sense, I've never seen a more promising, readier time for the changes we need."

 

Copyright © 2011 by the Catholic Health Association of the United States
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