Back to govern­ment

Ber­wick dis­cusses his run for Mass. gover­nor, goals for health­care re­form

Modern Healthcare - - THE WEEK IN HEALTHCARE -

Dr. Don­ald Ber­wick for­mally en­tered the Mas­sachusetts gover­nor race the day be­fore ad­dress­ing the Health­care Fi­nan­cial Man­age­ment As­so­ci­a­tion’s an­nual con­fer­ence last week. Pres­i­dent Barack Obama re­sorted to a re­cess ap­point­ment to in­stall Ber­wick, a co-founder of the in­flu­en­tial In­sti­tute for Health­care Im­prove­ment, as CMS ad­min­is­tra­tor dur­ing the early im­ple­men­ta­tion of the ACA. Ber­wick drew scorn from con­ser­va­tives through­out his 17 months on the job, and he re­signed in De­cem­ber 2011 when it was clear the Se­nate would not con­firm his nom­i­na­tion. Mod­ern Health­care News Edi­tor Gregg Blesch sat down with him to find out what’s draw­ing him back to govern­ment. Here is an edited ex­cerpt:

Mod­ern Health­care: What do you see as the un­fin­ished health­care busi­ness in Mas­sachusetts?

Dr. Don­ald Ber­wick: I am very proud of Mas­sachusetts. The state that I come from is the first state in Amer­ica to make health­care a hu­man right. We did that in 2006. And that’s worked. We have over 98% cov­er­age, I think, of adults, and 99% cov­er­age of kids.

That is a great achieve­ment. But that is not enough—you can’t have health­care guar­an­teed for ev­ery­body, or even most of us, un­less the health­care sys­tem is re­formed.

We have a health­care sys­tem that is very waste­ful; it is un­sus­tain­ably ex­pen­sive and it doesn’t meet peo­ple’s needs. They get harmed in care, the ball gets dropped, con­ti­nu­ity isn’t present and we need a new sys­tem—one that is con­tin­u­ous and pa­tient-cen­tered. The new law in Mas­sachusetts from last year is an at­tempt to do that and at the same time con­tain costs. And ac­tu­ally, that’s the way to con­tain costs. The best way to re­duce health­care costs is to im­prove the care. That’s been my les­son learned for 30 years.

MH: Is that a dif­fi­cult mes­sage to give to hos­pi­tal chief fi­nan­cial of­fi­cers—that what they need to do is in­vest money in ini­tia­tives that will re­sult in the govern­ment and con­sumers pay­ing them less?

Ber­wick: The ob­jec­tive is not just to spend less; it is to give bet­ter care, and that does re­quire pretty big changes in the way health­care is go­ing to op­er­ate. Af­ter all, we have a legacy sys­tem—we built it over a cen­tury— which is founded on do­ing more and more things for peo­ple with­out a lot of at­ten­tion to which help and which don’t.

The fee-for-ser­vice pay­ment sys­tem re­wards hos­pi­tals for stay­ing full, re­wards spe­cial­ists for stay­ing busy, and that’s what we get. Th­ese are good peo­ple; they are do­ing what the signals ask them to do. We need to change the signals now.

The best hos­pi­tal bed is an empty bed. The best MRI ma­chine is an idle one. Idle be­cause we don’t need it. So if we re­fo­cus on health, keep­ing peo­ple home where they want to be, pre­vent­ing the heart at­tack in­stead of just treat­ing it, as­sur­ing con­ti­nu­ity so er­rors don’t hap­pen, we will have much bet­ter care, but that means change.

I think that peo­ple of HFMA and the oth­ers who are masters of know­ing how to make or­ga­ni­za­tions work, they can do this, they can adapt to it.

MH: A num­ber of ef­forts to change the signals are in the Pa­tient Pro­tec­tion and Af­ford­able Care Act and were em­barked upon dur­ing your time at the CMS. As Dr. Richard Gil­fil­lan leaves the CMS In­no­va­tion Cen­ter, it seems like a good time to take stock of whether they are chang­ing the way health­care is de­liv­ered and paid for.

Ber­wick: We are see­ing a lot of change around the coun­try, and it is not just hap­pen­ing on the pub­lic side; it is hap­pen­ing on the pri­vate side, too. Pri­vate pay­ers and pub­lic pay­ers, we are on the same jour­ney. The whole pub­lic is on the same jour­ney. Who doesn’t want bet­ter care and who wants to keep hav­ing health­care take all the re­sources from other wor­thy in­vest­ments? So, we are en route. The Af­ford­able Care Act is a ter­rific start for that.

It is a law that I have enor­mous re­spect for and I think in some ways (is) un­der­es­ti­mated by the pub­lic. We never got the mes­sage across. The Af­ford­able Care Act does two things: It takes a step to­ward mak­ing health­care a hu­man right in this coun­try. But the other part of that law is to help health­care change so it can bet­ter meet those needs by en­cour­ag­ing con­ti­nu­ity, pay­ing for the care of pop­u­la­tions over time, pay­ing for co­or­di­na­tion, mak­ing sure we are pay­ing hos­pi­tals more when they get safer, when they in­jure pa­tients less and all of that is un­der­way.

We are go­ing to see turnover, but I think the mis­sion is clear. The tal­ents we have are great, and I am sure this is go­ing to work.

MH: When you were at the CMS, it was a very ugly time in pol­i­tics. How you are feel­ing about the prospect of get­ting back into govern­ment to achieve your goals?

Ber­wick: I want to get back into govern­ment. The ex­pe­ri­ence for me was won­der­ful. There was non­sense. I think that many of the at­tacks on me were ir­re­spon­si­ble. They were frankly lies. They were mis­char­ac­ter­i­za­tions of what I be­lieve, and de­spite my at­tempts to ex­plain what I be­lieve, they just wanted to say what they wanted. So that was a game.

For me that was more back­ground noise. We had a won­der­ful new law to try to im­ple­ment. We had the on­go­ing work of CMS, which pro­tects a hun­dred mil­lion Amer­i­cans. I saw what can hap­pen when govern­ment func­tions prop­erly in terms of pro­tect­ing peo­ple who need pro­tec­tion and help­ing ev­ery­body get to bet­ter health­care.

In Mas­sachusetts, that’s what I would like to do. I think Mas­sachusetts can be an ex­am­ple for the whole coun­try of suc­cess­ful pub­lic and pri­vate part­ner­ship and poli­cies that re­ally work for peo­ple. We call Mas­sachusetts a com­mon­wealth, and I love that term. You know, com­mon wealth. We are in this to­gether.

GREGG BLESCH

Ber­wick says the best way to re­duce health­care costs is to im­prove care.

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