Published by: Bruce Siegel on 11/30/2011 10:54:47 AM
The departure of Don Berwick from CMS makes me reflect on what we’ve accomplished in the past few years; and how much more needs to be done.
Don’s tenure coincided with an unparalleled period of innovation in US health care. Much of that stemmed from his leadership, and we owe him our thanks. But in some ways he gave voice to the hopes and fears that agitate American health care. How do we fix a system that is designed to underperform? What ethos will guide reform: that of the market or of the community? Will health care become a right or remain a commodity?
While Don propelled us forward, the answers to these questions are far from settled. The 2012 election will be a great referendum on these issues. The wheels of health care change have just begun to turn, and there is so much more to be done.
I was reminded of this in an NAPH webinar yesterday on population health. Dr. David Link of Cambridge Health Alliance demonstrated their groundbreaking work on improving care for child asthmatics. Good news: A registry in a setting of planned care can dramatically reduce emergency department visits and hospital admissions, cutting both by 45% or more. Bad news: The result was savings for health plans and less revenue to the health system that invested $250,000 annually in the program. For a safety net hospital like Cambridge already coping with dropping payments, it is simply not sustainable. A 75-year-old system of paying hospitals and doctors for treating sickness is blocking our building a better health system and draining our resources.
This if the sort of challenge we have done little to really fix in America. Don helped to point the way, but we need a lot more, a lot faster.