Things Unsaid
This week the newly appointed head of CMS, Dr. Donald Berwick, gave his first public speech since his appointment in July. As the speech opened, he mentioned a lot of the “what’s” of healthcare reform; costs must decrease, new ideas are needed, we must work together, change is imperative, etc He did not, however, mention much regarding “how” he intends to lead us there. Further into the speech however, Dr. Berwick may have given us a glimpse into his plan. He referred to a “three part strategy" to:
- Improve the experience of patient care;
- Attack population-wide causes of disease; and,
- Reduce per-capita costs of health care.
This strategy is an apparent reference to the “Triple Aim”, a concept first promoted by Dr. Berwick following its introduction in an article published in the journal Health Affairs in 2008.
Since his appointment, Dr. Berwick has been criticized for not outlining a solid plan to implement healthcare reform. When asked how he would do just that in his original article, Dr. Berwick did have a plan. That plan included some very difficult and not very politically popular suggestions: global budget caps on total healthcare spending, measurement and fixed accountability for the health status of populations of patients, standardized measures of care and quality, sharing of financial gains with those that help reduce cost and improve quality, and training clinicians to improve their ability to change processes of care. Curiously, Dr. Berwick chose not to include any of those suggestions in his speech this week.
Over the last few months, the healthcare reform debate has been peppered with cries of things that various groups will NOT do, but no one has yet emerged as the leader who has the ideas of what we CAN do to achieve meaningful reform. Among other attributes, leadership involves establishing a clear vision, sharing that vision clearly so that others can follow, and then providing the information, knowledge and methods needed to accomplish that vision. I may not agree with every tenant of Dr. Berwick’s plan, but he at least he (at one time) had a plan. By choosing not to continue casting his vision for that plan, the opportunity to become the leader healthcare reform desperately needs may just have passed him by.
While I do not disagree with you on our leaders needing a vision and a plan to carry out what likely is to be one of the most up hill battles in our country's history, I like the idea that innovation may not come from the top down. Innovation like many movements often comes from the ground up. The truth is, even applying the Triple Aim does not answer many of the implementation questions for redesigning healthcare. There are examples of healthcare innovation happening everywhere in the country. If a major goal is to decrease cost, let's start with defragmenting healthcare. If a major goal is to increase access, let's offer a way for people to afford health insurance. If a major goal is to be more effective, let's look at what works and what doesn't work! Berwick is smart enough to tell us what innovation we should do - but should he? It is not likely that one model will fit all. I, for one, believe that we will figure out ways to operationalize our respective innovation, and it will be a good thing that someone at CMS recognizes innovation and will listen.
"Coordination", "Cost", and "Communities", the alliteration I will use to explain to folks, represent a good framework and will make the message easy to communicate. Now that Dr. Berwick wears the mantle of CMS perhaps he has the authority to do what he was unable to do in 2001 when the paper was first published ?