Friday, March 29, 2013

Berwick calls for MGH to lead in health care reform efforts

A CRITICAL ROLE: From left, Susan Edgman-Levitan, executive
director of the Stoeckle Center; Bill Kormos, MD, education director
of the Stoeckle Center; Berwick; Michael Barry, MD, medical
director of the Stoeckle Center; and the late Dr. Sandler’s wife,
Mary Haskell.

“THE MORAL TEST OF GOVERNMENT is how it treats those who are in the dawn of life, the children; those who are in the twilight of life, the aged; and those who are in the shadows of life, the sick, the needy and the handicapped.”

It was this famous quote from former Vice President Hubert Humphrey that convinced Donald Berwick, MD, to accept President Barack Obama’s appointment as administrator of the Centers for Medicare and Medicaid Services (CMS) in 2010. He served in the role until stepping down in December 2011. On March 21, Berwick returned to the MGH – where he trained years ago – to deliver the Allan Sandler Visiting Scholar Lecture at the Department of Medicine Grand Rounds. The annual event was established in honor of Sandler, who practiced internal medicine at the MGH for more than 40 years.

During his presentation, “Clinical Leadership of Health Care Reform: The Opportunity Now,” Berwick addressed the standing-room-only crowd in the O’Keeffe Auditorium to speak about his experiences in Washington, emphasizing the critical role academic leaders play in reforming the American medical system. Berwick encouraged those in attendance to continue to focus on population health, prevention and chronic disease management in this new era of health care reform, a recommendation that mirrors the MGH mission of “improving the health and well-being of the diverse communities it serves.”

As administrator of CMS, Berwick said he embraced his charge to “not run CMS, but to change it.” He used a “Triple Aim” strategy – improving the patient experience of care, improving the health of populations and reducing cost — to achieve “Obamacare” goals of making health care a human right, expanding coverage for all and helping health care become coordinated and comprehensive. “You don’t get better at something unless you decide to make it better ... every improvement requires change,” he said.

Berwick has traveled extensively throughout the U.S., visiting the MGH and other innovative health care organizations that are testing new ways of delivering care, implementing changes and working to improve care in their communities – all with great success. He showed examples of systems in which innovations are producing new results – from Project Echo in New Mexico, to the South Central Foundation in Anchorage, Alaska, which provides care to the Alaskan Native Americans.

Recognizing both the challenges and the potential of transition, Berwick said the MGH is at a crossroads: the hospital can be afraid of change and become obsolete, or deal with change with the same courage and leadership it has used to successfully tackle many clinical and technological challenges of the past. Berwick warned against the former, highlighting the consequences of inaction – which include added burden on individuals; cutbacks in coverage; deterioration of schools, roads and wages; more restrictive public programs; and less generous private insurance.

Berwick said he is optimistic, and offered some principles to guide transformation at the MGH: put the patient first, protect the disadvantaged, start improvements at scale, return the money back to the payers and act locally. He reminded clinicians that they are guests in the lives of their patients, and emphasized that patients and families must be invited as partners in care design, process improvement activities and the governance system.

“There has never before been a better time, or more important role, for health care professionals to lead the reform and improvement of American health care as a system,” Berwick said.

Read more articles from the 03/29/13 Hotline issue.

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