The New Health Dialogue

One of our themes at the New America Health Policy Program has been how it's all interconnected -- how expanding coverage, restraining costs, and improving quality all go hand in hand. It was really interesting to see coverage advocates intersect with some of the experts in the cost and quality world at the second and third days of the Families USA Health Action 2010 Conference. (We already told you about how interesting we found the first day).

Improving Quality and Value

Friday morning kicked off with two keynote speakers: Dr. Elliot Fisher of the Dartmouth Institute for Health Policy and Clinical Practice, and Dr. Donald Berwick of the Institute for Healthcare Improvement. Click here to watch the webcast. If you've been following our blog, you know we pay close attention to their work.

As Dr. Berwick explained, the First Law of Improvement is as follows: “Every system is perfectly designed to achieve exactly the results it gets.” This is how we ended up with a system like ours. His suggestion? Speaking to a large and diverse group of health care leaders, he encouraged the crowd to implement changes at a local level, pushing us in a direction to achieve the Triple Aim: better health, better care, lower costs.

He asked that the audience approach change with three lines of attack. First, the technical approach: how do you improve a process? By taking it apart and putting it back together. Second, social support: how do you support process changes? By working together, forming collaboratives and encouraging people to learn from one another. And third, the strategic system: how do you align improvements? Organizational leadership must state the will and commitment to change, set forth ideas and follow through with the execution. The Institute for Healthcare Improvement is committed to improving health care systems and patient care around the globe. Check out their website for some ideas, and take a look at Dr. Berwick's PowerPoint presentation, here. 

Dr. Fisher presented the crowd with a simple history of the Dartmouth Atlas, pointing out the wild variations in health care spending across the country. How, he asked, can the best health care in the world cost twice as much as the best care in the world? He explained that the flawed conceptual model that people hold onto is that health is produced by the individual actions of good clinicians who are working hard. There’s more to a good health care system than just good doctors. He left us with four thoughts: have a common purpose and clear aims, redesign the system -- not ration, find local solutions and engage local leadership, and come up with new models and new measures. (The Dartmouth researchers have been criticized recently for not taking into account local economic conditions and prices. They went back and looked at local price differences in some new ways -- and concluded in an article posted on the Health Affairs web site that utilization, not prices, remains the key driver.)

Public Support for Reform

On Friday afternoon, Bob Crittenden of the Herndon Alliance and Jeffery Liszt of Anzalone Liszt Research shared their insights into communication, messaging and health reform. Liszt reminded the audience that health care is a deeply personal issue for Americans. When we talk about big systemic reform, deficits, and numbers, it’s easy to lose people and muddle the issue of how health reform will actually help American families. Process dominated the health reform debate this past year, Liszt said, and process can be ugly. What’s important about the bill is its good content -- and content is a battle pro-reform advocates can win. Crittenden said it was important to offer people proof that health reform will actually translate into something positive for all Americans. He encouraged lawmakers to share specific merits of the bill with their constituents (like no co-pays for preventative care). Also, he pointed out that the reform bill is sequential -- Americans should know that reforms’ provisions will go into effect over a period of years, meaning there will be time to exercise caution and change anything that doesn’t work the way it is intended.

Words of Inspiration

The conference ended with speeches from Rep. Chris Van Hollen (D-MD) and the Surgeon General of the United States, Dr. Regina Benjamin. Rep. Van Hollen urged the audience to put the recent Massachusetts election in perspective -- after all, he won election as a pro-health reform Democrat in a district that had been Republican since the Civil War during the heated August recess. He reminded us of the human costs of inaction on health reform -- millions will lose their coverage or go bankrupt from medical debt (or both), and many Americans will die in the absence of timely treatment.

As a practicing physician, Dr. Regina Benjamin has seen first hand the human tragedy that comes with uninsurance and underinsurance, especially in poor, rural and medically underserved communities. She shared heart-breaking stories about people who were too poor to afford adequate private coverage but had just too much to qualify for Medicaid. She described one woman who had health insurance through her job at a local school but could not afford the co-pay for pain medication. It’s unfair that so many Americans work hard everyday but still cannot afford or access the care they need. Dr. Benjamin encouraged pro-reformers to keep fighting in the days ahead. One person can make a difference, she said, and “every little bit helps.”