The New Health Dialogue

Senate Republicans eager for a face-to-face with the new CMS Administrator Don Berwick got their wish. Dr. Berwick appeared today before the Senate Finance Committee for a hearing on the future of Medicare and Medicaid. Democrats focused their questions on how Dr. Berwick and the Affordable Care Act could improve the American health care system, while Republicans focused on Berwick’s nomination (he took office as a recess appointment, without formal Senate confirmation) and the length of the hearing. (The hearing was cut short by a vote on food safety legislation on the Senate floor, which irked many committee members -- Senator Hatch called the time available “pathetic”).

Berwick opened his testimony by recalling his father’s long career as a general practitioner, and what he had learned from it -- Berwick’s vision of health care is responsive, embedded in a community and connected to it, and focused on the needs of patients and families. The health care world today is full of new and wonderful technologies, Berwick said, and is much more complicated -- compared to what his father could do in his day, our current health system can work miracles ... when everything goes right.

Berwick asserted that the best treatment should be within reach of every American, but we must also make meaningful efforts to contain rising costs. “Better care leads to lower costs through improvement of care...it isn’t just possible, it happens every day in this country,” said Berwick, giving the example of quality improvement at Denver Health. They reduced their cost by $50 million by reducing waste -- like cutting out extraneous paperwork for nurses.

Berwick named his key priorities for the health system, saying that they are within our reach:

1. Protect the public trust, ensuring the longevity and viability of the system, and make CMS a much more effective agency -- he wants them to work better with other parts of government and the private sector.
2. Better care for individuals, especially around issues such as safety and patient-centeredness.
3. Better health for the American people -- get really serious about prevention, this will improve outcomes and population health in the long run.
4. Achieve better integrated, coordinated care, and help provider settings all over the country figure out and reach out for better ways to care for patients. Better care delivery, and improvement, will play a very serious role in achieving the goal of lowering costs.

Berwick said that the biggest waste of all comes from failing to meet the needs of the chronically ill. You probably know someone who has cancer or heart disease, said Berwick, “so you know that they need health care that helps them through journeys, not fragments.” These patients need us “not to drop the ball,” not to forget their names, or problems or medications, he said. Better coordination of care for these -- and all -- individuals in the health care system will lead to less waste, and lower costs.

He argued that the Affordable Care Act is a very significant opportunity to make progress in getting the health system our nation wants and needs, mentioning Medicare beneficiaries who were already getting relief from the doughnut hole, and seniors who now had easier access to preventive care. He also mentioned improved data reporting and measurement, efforts to crackdown on fraud and abuse, and the creation of the CMS Innovation Center.

Many Senators expressed regret (such as Senator Grassley) or anger that Berwick had received a recess appointment, and was not able to be vetted before the Senate. An outraged Senator Bunning warned Berwick that he was going to spend a lot of time getting grilled by Republican-led House committees next year. He demanded to know why Berwick had agreed accept a recess appointment. “The President of the United States asked me to serve, to get to a better health care system that we all want and need,” responded Berwick, “That’s what my career has been devoted to…and I feel very privileged to do it.”

Berwick’s ultimate message is that progress in health care is a double edged sword -- with new technologies, tools and cures comes new complexities, challenges, and dangers that both doctors and patients have to navigate to achieve the care they want. As Berwick said, “I am honored to join the CMS at a historic time, a time of enormous promise for the future of our nation’s health care.”

Watch the proceedings for yourself here, and read Dr. Berwick’s testimony here.