Donald Berwick, M.D., formerly acting administrator of the federal Centers for Medicare & Medicaid Services (CMS) and a new official candidate for Massachusetts governor, spoke passionately to a large audience on June 18 at the Healthcare Financial Management Association's (HFMA) annual conference in Orlando, Fla. about transforming America’s healthcare system.
Berwick, founder and CEO of the Cambridge, Mass.-based Institution for Healthcare Improvement where he served until 2010, began his keynote address by telling the sizeable crowd that they have become crucial to the healthcare system. “This is a moment of very special opportunity. There is really big change happening right now, and you’re about to move from the engine room to the wheelhouse. We need you as pilots,” Berwick said.
Berwick said he was thrust into this problem when he joined CMS in 2010, upon being asked to by President Barack Obama. “We had tremendous economic pressure in the country as a whole—there was the fiscal cliff, private sector economic distress, confusion in the public and in the professions, a loss of authentic dialogue, and political polarization. A tough problem was made tougher by all this.”
Berwick claimed that we have taken all of the money for healthcare, money that could be going to roads and schools. Nearly 18 percent of the gross domestic product (GDP) is spent on healthcare in the U.S., and the next highest country is about 12 percent, he stated. “This is what we mean when we say it’s unsustainable. And changing that is a difficult problem, but especially at a time of enormous economic distress when capital is much less available.”
The nation needs to get back to basics, preached Berwick, saying that the first law of improvement is that every system is perfectly designed to achieve exactly the results it gets. Aim and method are the first two parts to improvement, he continued. “You can’t improve by accident; you have to decide to improve. That’s aim. Then you need an approach. You’re not just yelling at yourself or someone else. You work on it and make changes.”
The consequences of inaction, Berwick said, are cutbacks in coverage, weakening the safety net, putting more burden on individuals (who have to pay more out of pocket whether they could afford it or not), research and teaching under siege, and all payers being affected—not just the government.
There is so much waste in the system, he said. "Put patients first and give the money back, said Berwick, getting a chuckle from the audience when adding, "I know this will produce hives for many of you.”
For a solution, Berwick showed the audience seven examples of healthcare systems that work, starting with Southcentral Foundation’s Nuka System of Care in Anchorage, Alaska. Nuka has what Berwick called “team-based care to the max,” delivering health, not just disease care. At Nuka, relationships are the key to healthcare; that patient care should be integrated, there should be same-day access to primary care; patients are partners in their own healthcare and there should be given ample opportunity to offer advice and feedback.
After five years at Nuka, emergency department (ED) use was reduced by 50 percent, hospital admissions were down 53 percent, utilization of specialists were down 65 percent, staff turnover rate was down 80 percent, and primary care utilization was down 20 percent. Overall, the quality rates were tremendous, said Berwick, and it is all done at two-thirds the cost of other providers.
Ultimately, Berwick has put the onus on healthcare CFOs, urging them to not wait for Washington D.C., as we don’t have the time. "You can't say it can't be done. It can be done,” Berwick claimed. “It's not a problem of possibility, it's a problem of will."