The First Mile on the Marathon of Reform

Last June, I became a regular contributor to The Washington Post’s “Health Care Rx” blog, which provided space for me and other experts from across the industry to comment on the current state of the health system and offer real-world insights into how to improve health care. Now, given the recent passage of health reform legislation, the blog will come to a close. The final question came on Monday:


This week, President Obama plans to sign into law a budget "reconciliation" bill that includes the final changes to the new health-care overhaul. What is your assessment of the now-complete health law and its implications for the future?


My response, The First Mile on the Marathon of Reform, is below:


The mainstream reform debate has been primarily focused on access -- the millions of Americans who don't have insurance. We heard heartbreaking story after heartbreaking story day after day for nearly a year. And this bill tackles that enormous problem!


But there are the other big problems -- skyrocketing costs, misaligned incentives, inferior and inconsistent care, and so on -- all stemming from the fact that our health delivery model has remained what is essentially an acute, episodic care business model from the 19th century; a traditional fee-for-service model based on patients visiting hospitals and physicians' offices when they're sick. We have a system that hasn't evolved to keep up with the way our nation's health has changed -- toward chronic care. Nor has it progressed to use health data in an effective way to drive better decision-making and improved methods. It's not set up to enable the kind of broad-scale innovation and consumer-focus that has transformed nearly every other industry that touches our lives. Nor is it poised to keep up with and take advantage of advances in medicine, especially to deliver on the promise of personalized medicine.


In the context of these massive structural problems, while the bill is a positive step forward, it seems like it's just the first mile on the marathon of reform.


There are other good "ideas" from "experts" in the bill besides access to address some of these problems -- an Innovation Center within CMS to pilot payment reform, a Patient-Centered Outcomes Research Institute to identify and carry out national research priorities to drive "evidence-based" medicine, a Medicare shared savings program to pilot cost-savings for accountable care organizations, and so on. But these will require doing a fundamentally better job of running pilot and demonstration programs in Medicare. Right now, we evaluate the reforms over 8 to 10 years. We need to lower that dramatically to accelerate the path for these ideas to 'scale' and become common practice -- driving the kind of wholesale transformation needed.


Most people recognize that it will take several years to get reform "right"-- we have an opportunity to do even more to drive innovation and shift the system to drive real value for every dollar spent. I hope that we will continue to work at driving the right combination of structural change, innovation, and use of technology to create a better system for our generation and those to come.

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