Leading Advocate for Health Care Quality Sees Optimism
| Oct. 14, 2015 | Citing innovations across the country, a leading national advocate for health care quality expressed optimism that delivery of care in the United States can become more effective, more efficient and less expensive in the future.
Donald Berwick, M.D., (left) and UAMS Chancellor Dan Rahn, M.D.
Donald M. Berwick, M.D., president emeritus and senior fellow at the Institute for Healthcare Improvement and also a former administrator for the Centers for Medicare and Medicaid Services, delivered the 2015 Winthrop Rockefeller Distinguished Lecture on Oct. 13 to a full auditorium at UAMS. The presentation also was broadcast to remote sites on the UAMS campus, at Arkansas Children’s Hospital and UAMS locations across Arkansas.
“I’m in a place where I feel tremendous hope for what can happen,” said Berwick, who was appointed to lead the Centers for Medicare and Medicaid Services four months after passage of the Patient Protection and Affordable Care Act. His tenure there, through December 2011, included overseeing development of policy for implementing the law.
The complicated law actually encompasses two laws, he said: an insurance reform law that expanded coverage to more Americans and dealt with coverage for preventative care, prescription benefits and coverage of children through age 26; and another law more concerned with health care delivery reform with a focus on how care is paid for and mechanisms for value-based payment, accountability and reducing medical errors and fraud.
He termed the transition of the nation’s health system under the law from its current state as a sort of expedition. The goal is a place of improvement with more patient-centered care that is more effective, timely and equitable. To get there, the journey will be challenging and today’s practitioners must leave a system they are familiar with — where technology has developed cures for diseases once invariably fatal and care delivery designed around volume and doing more regardless of cost.
Donald Berwick, M.D., delivers the Winthrop Rockefeller Distinguished Lecture at UAMS.
It’s also an expensive system where the quality of care and patient outcome often depends on where one lives — even varying dramatically within a few miles, he said.
“We’re spending 50 percent more per capita on health care than any country on Earth,” Berwick said, noting the country’s health care system still does not capably and consistently address issues of chronic illness and prevention.
At the Institute for Healthcare Improvement, Berwick was an architect for the Triple Aim approach to health care performance — improving the patient experience, improving the health of the population and decreasing the cost of care. The philosophy can be a key to improving the nation’s system under the health reform law, he said — though quick to add “and I don’t mean lowering cost through rationing care.”
He cited the non-profit Southcentral Foundation’s Nuka System of Care in Anchorage, Alaska. He said the customer-owned health system serving Alaskan Native people incorporating a patient-centered medical home model and emphasizing team-based care has seen costs decrease while patient satisfaction increased.
Berwick pointed to millions in savings realized by Denver Health through implementation of Lean concepts to eliminate waste and improve efficiency through standardization of some processes. He credited the movement as a factor in the system reporting the lowest mortality rate of any of the nation’s 113 academic health centers.
Project ECHO in New Mexico, he said, leveraged telemedicine and distance learning as a method to link health care providers in rural clinics with specialists and improve access to quality care for patients with hepatitis C.
There’s PEEK, a smartphone application that allowed camera-equipped phones to be used for eye exams in remote areas. The camera can be used to scan the eye lens and data can be transmitted wirelessly to a doctor. The app is being used in Kenya to conduct vision screenings on thousands of school children weekly.
These and other examples, Berwick said, showed that health systems can change and improve care in alignment with the ideals of the Triple Aim. There may not be just one answer but a “quilt” of answers such those examples, he said.
Academic medical centers like UAMS can play a critical role in bridging the gap between the system the country has had and the one it needs, he said.
“We need builders and who better than the great centers of knowledge and health care,” Berwick said.
For academic health centers, the role is teaching young health care professionals how to perform interprofessional, team-based care; promote research into health system improvement; foster innovation in health care delivery; and embrace the Triple Aim and demonstrate how it can be successful.
“We need to be asking patients not ‘what’s the matter with you’ but ‘what matters to you’.”
The Winthrop Rockefeller Distinguished Lectures were established in 1972 by friends of former Arkansas Gov. Winthrop Rockefeller. The endowment that funds the lecture program allows five universities in the University of Arkansas system to offer free public lectures that communicate ideas to stimulate public discussion, intellectual debate and cultural advancement.