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Fixing Healthcare Requires a "Return to Purpose," Berwick Says

The former CMS administrator, who coined the term "the Triple Aim," offered a vision for the next era of healthcare innovation at a summit presented by Horizon Blue Cross Blue Shield of New Jersey.
The current era has brought medicine from quality control—just fixing what’s broken—to quality improvement, which creates systems for ongoing change. But reaching the stage of quality planning—which calls for innovative leaps—requires radical change, and it doesn’t happen on its own. Quality requires investment, Berwick said, and “a healthy dose of innovation.”

The triple aim, he said, can’t be built on the current system. “You’ve got to have some new stuff.”

Which brings healthcare to what Berwick sees as a coming era, one that combines the professional pride of his father’s generation with the transparency and accountability of more recent times. Berwick calls it the era “of return to purpose.” He spelled out 9 elements:
  • Avoid excess measurement. Accountability is good, but “this country has gone mad with measurement.”
  • Abandon “complex incentives.” This is especially important for individual practitioners; Berwick said such programs were not only impractical, but they did not “respect” the physician. This requires trust, he said. “If you trust the motivation of the work force, you can put your carrots and sticks back where they belong,” he said.
  • Get of the billing “treadmill.” “We’ve got to stop focusing so much on the money,” he said. This will require innovative payment models and greater movement away from fee-for-service. Berwick, who has estimated that up to 30% of healthcare is waste, blasted the use of consultants to “squeeze” every dollar from patients and insurers.
  • Be part of a team. Berwick said physicians must learn to “give up professional prerogatives at the expense of the whole,” which does not invite disrespect but recognizes that no one today can practice in isolation.
  • Commit to quality science. This includes embracing healthcare redesign principles. “For modern quality methods to work, you have to use them,” he said.
  • Promote transparency. Berwick called this “the opposite of secrecy.”
  • Protect civility. “Everything that is possible begins with civility,” he said.
  • Believe in the power of the patient. This, he said, is what the term “patient-centered” is about: the transfer of control of care to the people being care for, which Berwick said is distinctly different from giving patients a bigger share of the bill.
  • Reject greed. Berwick spared no one here—not pharmaceutical companies, not hospitals that he said, “jack up” prices after consolidations, not consultants who promote excessive use of codes to collect extra revenue.

These are challenging times, Berwick said, citing research that shows about half of today’s doctors would not advise a young person to enter the profession. “The pressures are enormous,” and are not helped by the current political climate, he said. “More and more you feel like you’re in a gerbil cage.”

But there are reasons to be optimistic. In a separate interview with The American Journal of Managed Care®, he discussed how young healthcare professionals are embracing the quality movement through online learning, and how many good examples of healthcare delivery systems exist. “You’ll find gems everywhere,” he said.

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