Don Berwick’s highest priority as Administrator of the Centers for Medicare and Medicaid Services is transforming the American health care system in accord with the vision set forth in his 2008 “Triple Aim” Health Affairs article. (This article and all of Berwick’s Health Affairs writings are freely available in full to all readers.)

Berwick spoke about his policy goals yesterday at a Medicare conference sponsored by the health insurers’ trade group AHIP, in his first major public address as CMS administrator. He listed two other priorities quite sizable in themselves:  “running a very large – and I intend a very effective – health insurance system,”  and implementing the Affordable Care Act, which he labeled “a thrilling law.” But he called pursuing the Triple Aim “personal” and said “it’s the job that I came here to do. It’s my main focus.”

As described in the Health Affairs article and by Berwick in his speech , the Triple Aim consists of (not surprisingly) three overarching goals:

  • Better care for individuals, described by the six dimensions of health care performance listed in the Institute of Medicine’s 2001 report “Crossing the Quality Chasm”: safety, effectiveness, patient-centeredness, timeliness, efficiency, and equity.
  • Better health for populations, though attacking “the upstream causes of so much of our ill health,” such poor nutrition, physical inactivity, and substance abuse.
  • Reducing per-capita costs.

Berwick, who has been accused by Republicans of favoring rationing of health care, said costs should be reduced by eliminating “waste, needless hassle,” and “what does not make sense in our health care system.” He emphasized that costs should not be reduced by eliminating any helpful care or by “harming a hair on any patient’s head.”

Making Safer Care A Top Priority

Within the Triple Aim framework, Berwick called for making acute care more safe and reliable, making care more integrated, and increasing the nation’s investment in preventive care. Asked by AHIP President and CEO Karen Ignagni to name a first priority, Berwick chose safer care and reducing medical errors, one of the main focuses of the September Health Affairs issue.

Berwick stressed that health care transformation “won’t yield to a massive top-down national project.”  He explained: “Successful redesign of health care is a community by community task. That’s technically correct and it’s also morally correct, because in the end each local community  — and only each local community – actually has the knowledge and the skills to define what is locally right.”

An invitation and a warning. Speaking only a few days after Health and Human Services Secretary Kathleen Sebelius rebuked insurers for excessive rate increases and blaming those increases on the Affordable Care Act, Berwick invited AHIP audience to work with him in transforming the health care system.  “My door is always open,” he said. However, he also issued a warning: “Those who seek only to preserve the status quo are not going to be constructive contributors to our nation’s future. They can’t be effective partners, because we need so much change.”

To a questioner who noted that insurers had been cast as “villains” by the Obama administration, Berwick urged looking forward rather than looking back. “If we really work together to make care become what it can become … trust will resurface,” he said.

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