The New Health Dialogue

Here's something that makes no sense to me.

Last summer, in one of my favorite posts on this blog, I wrote about an ambitious, creative attempt to reinvent and improve health care for low-income people with chronic disease in Washington DC -- which describes a lot of the residents of our nation’s unhealthy capital. The Chronic Care Initiative included rival hospitals and community clinics -- people who don’t often sit down in one room together -- in a collaborative quality initiative that included projects ranging from cell-phone apps for diabetes self-care to strategies for getting hospitals to let clinics know when their patients are admitted (which turns out to be way way way harder than it sounds). I have had the privilege of sitting in on a few of the group’s sessions, and had planned to write more about the individual projects as they come on line in the next few months.

This month, the head of the program -- Dr. Joanne Lynn, a nationally recognized clinician, researcher and author -- was fired. The future of the program is unclear. A Department of Health spokeswoman hasn’t answered my email (and I’ll update if she does). A couple of people affiliated with the initiative that I ran into at an Institute for Healthcare Improvement conference this week were either noncommittal about its future, or confided that they had doubts it could thrive without her.

I am not completely objective about this. I have known Dr. Lynn’s work for about 15 years and have gotten to know Joanne personally in the last three or four years. I respect her. She's interesting. Look back at how I introduced the project:

[The Chronic Care Initiative is] taking the lessons of quality improvement and the goals of population health and applying them across an entire city with an unhealthy population and a fragmented health care system that in its current form is not conducive to managing chronic illness. The Chronic Care Initiative is, in essence, an attempt to reinvigorate primary care (and common sense) in Washington, and to apply city-wide what quality improvement wonks called the Triple Aim goals:

1) Improve the health of the population

2) Enhance the patient experience

3) Get Value

That's a tall order in the best of circumstances. Here they are trying to achieve the Triple Aim for an unhealthy population that includes lots of people who are poor, sick, and members of racial or ethnic minorities.

The CCI initiative is not abstract. It is highly pragmatic. Grantees had to work on something small that, if successful, could very quickly become something big. It had to spread. They also had to be open -- because it was a collaborative cross-silo, in some cases cross-status (older established academic medicine center physicians with nurses  in community settings). They had to be flexible. If something in their idea wasn’t working out, they had to be agile enough to try something different. Improvement and innovation not as an endpoint, but as an ongoing part of health care delivery.

Some of the programs are about to come online -- and I still plan on writing about some of them. Washington certainly needs the help. According to data Joanne Lynn shared in an IHI presentation this week, Washingtonians have a life expectancy eight years lower than the U.S. average. The city has high rates of serious mental illness (10 percent), diagnosed diabetes (5 percent), and overweigh (half). It has the highest U.S. rate of end stage renal disease and amputation. And health care here is expensive -- 70th percentile on Dartmouth Atlas measures.

Not many people, including local media, paid all that much attention to this interesting endeavor when it began. Maybe they will take note now that it could end.