The Only Thing that is Certain about Health Reform

Posted by Dawn Marie Bailey

“The only thing that is certain about health care reform is that health care is going to be reformed,” says Chris Jennings, president of Jennings Policy Strategies and former senior health care advisor to President Bill Clinton.

Recently, I had the privilege of listening to Jennings and Dr. Donald M. Berwick, former president and CEO of the Institute for Healthcare Improvement (IHI) and former administrator of the Centers for Medicare & Medicaid Services, as part of a free IHI audio program entitled “Navigating the Elections with a Clear-Eyed View.”

I also recently had the privilege of attending a presentation by Kerry Weems, vice president and general manager of Health Solutions, General Dynamics Information Technology, at the ASQ Quality Service Conference on the need for health care practitioners to rethink how they measure quality.

Both presentations underscored the need for the health care industry to change the way it has always done business and to change it in a way that providers become wholly accountable and driven by quality and putting the patient first. The additional challenges to all of this are the “maelstrom of uncertainty” and the “large disruptive forces” in the environment.

Here are my personal takeaways:

  • Presidential Election: All agree that no matter who is elected, all signs point to the need for health care organizations to become more accountable in their delivery of high-quality health care in ways that give purchasers better return on their investment.
  • Moving Forward Now: Most health systems are moving ahead now with reform–reform of how they pay physicians, handle Medicare and Medicaid, and reduce debt. The private sector is demanding it. “The train has left the station,” Berwick says, “health care is never going back to the status quo. . . . We are going to have to be less dependent on acute care, more accountable, more transparent, with decreased costs.”
  • Benefits Programs: The ways in which the health care industry commits to safety net programs, including Medicare and Medicaid, will need to change . . . but responsibly. “Vulnerable people depend on state and federal support. The consequences are quite large, especially for disadvantaged populations,” says Berwick.
  • Community Support: Many in the health care community are supportive of reform. Jennings says that the health care community “saw the trend line anyway, saw the increasing number of uninsured Americans, making it hard to sustain a workable model.”
  • Integrated Care: The overall picture is that reform will inevitably lead to integrated care and reduced cost. Berwick says that the demand for integrated care is part of the public’s “demand for seamless care.”
  • Accountability and Measurement: Weems says that for a long time, the health care industry resisted measuring for quality, but the growing consensus is that large data sets are needed to better predict and understand patients, as well as be accountable to them. He uses an example of an office visit between a physician and a diabetic patient. It’s not appropriate for the physician to simply hand a brochure to the nurse to give to the patient; the physician needs to give the patient one-on-one education and perform all of the clinical checks and tests to ensure the patient was cared for appropriately. “It’s time to link reimbursement to actual performance,” he says, pointing out that patients need the “value proposition” and the “comparable effectiveness” of their physicians.
  • Uncertainty. Uncertainty plays a key factor in today’s health care environment. Says Jennings, “Most people know the direction they’re heading but not the path. [Health care] is looking at what kind of reliable payments can I count on, what populations are covered or not covered. . . . [In addition,] the public does not completely understand or have trust in the redesign of care.”
  • Disruptive Forces/Technologies: Weems says that some of this uncertainty comes from “large disruptive forces” that may include innovations and changes happening very rapidly and outside of regulations and the norm. He gives an example of the “smart carpet” that has monitors to detect whether someone is having a stroke simply by his or her gait over the carpet. How to regulate or incorporate such an innovative technology into health care is a new challenge.
  • Framework: Weems advocates for a framework to help health care organizations better teach, measure, and improve quality, especially in light of disruptive technologies.

My personal takeaways from these presentations, especially the thoughts around a need for a framework, certainly made me think about the Health Care Criteria for Performance Excellence–a framework specifically designed to help health care organizations think systematically, plan for the future, put patients first, and measure themselves.

Whatever the redesign of health care will eventually be, I certainly would want a framework to help me organize and focus on the myriad of payer pressures, disruptive forces, and uncertainty that will inevitably come with it. How about you?

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