Don Berwick copy

Governments

Q&A With Don Berwick, Former Administrator of the Centers for Medicare & Medicaid Services

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Don Berwick copy

Dr. Don Berwick is one of the most outspoken advocates for quality healthcare reform in the U.S. The former administrator of the Centers for Medicare & Medicaid Services, founder and CEO of the Institute for Healthcare Improvement, Honorary Knight Commander in the Order of the British Empire for his efforts in improving Britain’s healthcare system and author of Curing Health Care and New Rules: Regulation, Markets and the Quality of American Health Care now travels the country for speaking engagements.

Also, he just announced he’ll be running for governor of Massachusetts, the pioneering U.S. state in health reform, in 2014.

Berwick took a moment to talk with HealthBiz Decoded about technology and the future of healthcare after giving the keynote address at the Midas+ annual symposium, a gathering of representatives from the group’s 1700 clients and partners.

The following has been edited for length.

Q: How can providers, innovators and policymakers use technology to fill in the gaps in healthcare reform?

A: Here are some categories of relevant technology: first is the electronic medical record. The idea that we still use paper records in an era when we have much better ways to store and retrieve knowledge, that’s very outmoded. Of course, electronic records bring along their own hazards, but on the whole, having a record that’s instantly available, where knowledge can be exchanged right away between consultants and primary care, where patients have access to their own records, where nothing is lost, all this is bound to improve continuity and coordination of care, which is what it’s all about now.

With respect to transparency, we have a lot of trouble in healthcare because of the history of opacity where we don’t really know how well we’re doing much less how others are doing, and when we change that with better metrics and more daylight in care, largely through technologies, we can all learn better. We can find out who’s doing something the best and then make them our teacher.

We’re using technologies in really exciting ways around the country to move knowledge to the patient. For example, I’ve been speaking a lot about the ECHO project (Extension for Community Health Outcomes), that’s a project of Dr. Sanjeev Arora, at the University of New Mexico. He’s found a way to coach primary care doctors and nurses all over New Mexico in proper management of Hepatitis C, HIV and AIDS care, suicide, suicide prevention and obesity management. So instead of having patients come to a medical center, he’s moving the knowledge out to where the patients live, and that’s very leveraged. It really lowers costs and improves outcomes at the same time.

Q: The next step in Health Information Exchanges – online data networks that connect patients’ electronic health records from different health systems – is putting information in the hands of consumers. Why is that next step so important?

A: Oh it’s very important. The modern view of knowledge is that it should be available widely and transparently too, and health information exchanges are key interfaces for the interactions between all the reservoirs of information. HIEs will help smooth the way for much more integrated platforms for use of health data, obviously subject to very strict concerns about privacy, but I’m sure those concerns can be honored, and things will only get better and better as patients have more access to their own data.

Q: In your keynote this morning you talked about familiarizing patients with the boldest forms of patient-centered care. What would they be?

A: The more we help patients to become powerful in their own care the more confidence we see, people have tremendous capacity to take care of themselves when they know more about themselves.

Monitoring status, home-based monitoring, adjusting your own medication under proper guidance, engaging in prevention behaviors, these are all things can improve the capabilities for patients and their families to take better care of themselves.

The least costly and most effective way for people to get healthcare is when they know how to take care of themselves, if they don’t have to go to a hospital or see a specialist, they know so much about themselves.

Q: After having all of these experiences in healthcare, what is your general attitude about the future?

A: I’m optimistic, although there’s a horserace going on right now, we have to change care in America, to make it more seamless, more coordinated, to make it better care, and that’s going to be hard to do. It’s very possible to do, we know what the models look like, we know what better care looks like, but it’s a long and tough journey.

The alternative is much worse and that’s cutting care. What I’m worried about is that if we don’t get about the serious job of improving care we will end up really hurting people by cutting back on their care and that’s not what I want to see happen.

Q: Can you see a light at the end of the tunnel, five or ten years down the road?

A: It’s going to take a few years to actually get momentum toward the integrated care we need, but there are some great examples, and if we just study the ones that are working and make them more general, we can win.

The example I mentioned in my speech that I think is well worth studying a lot is the Nuka system up in Anchorage Alaska which is a coordinated, team-based system of primary care, quite successfully giving better health and lower cost to Alaskan natives. They’ve reduced hospitalizations substantially by keeping people healthy, using home community, home resources, and really working on prevention, it’s been highly successful.

Q: And that would help close the gap for those people in our country still without access to care.

A: Better care at a lower cost, those are the resources to make healthcare what it should be, which is a human right.