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“Out Of The Blocks”: Meeting The Challenge Of Transforming Health Care



December 11th, 2012
 
by Don Berwick and Clifford Marks

No other presidential election in American history has been freighted with such significance for health care as was last month’s vote. Uncertainty over the future of health policy dominated the discourse, and we all waited with bated breath for clarity from the voters.

Thirty-six days ago, we got just that. In one night, much of the uncertainty that had marked the past few years faded into history.

But now we all face a different and urgent kind of uncertainty — a pressing question: How, with this newfound certainty in the policy environment, can health care stakeholders best move forward on problems of high costs and suboptimal quality, of poor coordination and preventable medical error, soon enough to meet the social need?

Time is running out to find answers. Health care costs, much of them waste, continue to climb, and too many patients are not getting the high-quality care they need. If we do not act — and act quickly — to transform health care, we will face blunt cost cutting and declining access and quality, particularly for the poorest among us.

This is the challenge we face.  To help meet it, on November 8, just two days after the presidential election, the Institute for Healthcare Improvement brought more than 100 health care leaders to Washington, DC for a conference about the path forward for health care. Our aim for the “Out of the Blocks” conference, as we called it, was to seek the wisdom and insights of the nation’s foremost health policy experts, a roster that included former Senators William Frist and Tom Daschle, as well as panelists from all corners of the health care world.

Lessons From The “Out Of The Blocks” Conference

They did not disappoint. Together, the conference speakers and attendees laid out elements of a vision for rescuing health care, for reducing waste, for better focusing care on patients, for engaging families and communities, and for remedying the current fragmented structure of health care. We were honored that they were so willing to share their insights with us, and we are delighted to be able to share their ideas with you. Their recommendations are collected in a 14-page report published this evening, and some of their thoughts are excerpted below:
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  • Providers should step up now to the challenge of changing care processes, aiming for redesigns that both cut costs and improve care — including the use of telemedicine, group appointments, social media and community campaigns.
  • Increased transparency about costs and quality is crucial to the next phases of progress.
  • Happily, providers are growing increasingly open to transparency of clinical and cost data. This raises the possibility of a “grand bargain,” in which providers agree to more transparency and lower costs in exchange for less onerous regulation and more room to innovate in an environment of payment austerity.
  • States should pay close attention to the interfaces between Medicaid enrollment and opportunities to gain coverage through the new exchanges under the Affordable Care Act to ensure that incompatible eligibility systems do not result in coverage gaps for citizens.  Achieving the maximum degree of expanded coverage possible under the Affordable Care Act is a crucial goal.
  • Revenue pressures are driving closer collaboration between physicians and managers, and between providers and payers, creating a more innovative environment to facilitate faster improvement.
  • Speed is of the essence in transitioning from volume-based to value-based reimbursement.  Mixing models of payment — having to respond to both types at the same time — is uncomfortable for providers, who fear being caught in a transition state in which they lose financially for making positive and much-needed changes to care delivery.

Our own view, reinforced by the active dialogue at this conference, is that a window has opened for providers of care to take the initiative to prove that lower cost and higher quality are not only compatible, but strongly linked.  The November vote has stabilized for a time the new policy framework of the Affordable Care Act, giving hospitals and physicians a chance to make badly needed improvements in the safety, continuity, quality, and efficiency of care.  If they redesign care now, they can prove to the nation that universal coverage and excellent care are both within our grasp.  But the window will not stay open for long if results are not forthcoming.  American health care providers face an opportunity and a test — now.

The care providers at the conference showed acute awareness of the need and the stakes.  They also evinced a willingness we had not heard so clearly before to find ways to reduce costs while improving care.  Insurers, employers, and other stakeholders were equally intent on change.  It seems the question is one of execution — translating the rhetoric of urgency and change into a reality of better results soon enough to intercept the otherwise inevitable backlash from those who feel that we are on the wrong path.

A Daunting Challenge, But No Shortage Of Innovations

With a challenge so daunting, there was, unsurprisingly, no shortage of angst at last month’s conference. But there was also palpable hope and optimism: Panelists cited example after example of innovative providers who have redesigned care around patient needs, who have bent the cost curve, who have driven down preventable medical errors and seamlessly coordinated care. Health care reformers and improvers now have an unprecedented opportunity to spread those innovations; they can make system redesign, reliability, care coordination, safe care, and population health as much a part of the language of health care reform as access and affordability have been for decades.

We hope this report will help you seize this opportunity to implement and find solutions — bridges, as we term them in the document — from the care that we have today to the care that we need and, with your help, will have tomorrow.

We would like to thank all the panelists and attendees for sharing their knowledge, and in particular we want to thank IHI’s CEO Maureen Bisognano and IHI’s Board Chairman Dr. Gary Kaplan (Chairman and CEO of Virginia Mason Medical Center), who co-chaired the conference. Many thanks also to Health Affairs, our media sponsor for the event.

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2 Trackbacks for ““Out Of The Blocks”: Meeting The Challenge Of Transforming Health Care”

  1. Health Care At the Policy Conference » Progressive Massachusetts
    March 12th, 2013 at 3:15 pm
  2. » Progressive Massachusetts
    March 12th, 2013 at 3:11 pm

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