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White Coats in the Room: The Overlooked Ingredient in Health Reform

White Coats in the Room: The Overlooked Ingredient in Health Reform

With the death of Apple founder Steve Jobs, there has been a lot of analysis of his vision and leadership that has led us all to a transformed digital world.  Visionaries like Jobs are rare, yet the reach of their work often strengthens our society.

On September 23rd, I participated in small roundtable discussion convened by another visionary leader, Dr. Don Berwick, a physician and founder of the Institute for Healthcare Improvement.  As the current Administrator for the federal Center for Medicare and Medicaid Services (CMS), Dr. Berwick invited thirty "critical thinkers" from New England to discuss their insights, experiences and ideas about health care innovation.  Over the course of the two hour discussion, only one person, Jim Harnar from the Daniel Hanley Center for Health Leadership, highlighted the issue of leadership development as a key strategy to push innovation and reform. 

Jim's remark reminded me of another meeting I participated in a decade ago when I served as a senior policy advisor to the heads of two agencies in the federal Department of Health and Human Services (DHHS).  At this meeting nearly thirty staff members from ten different DHHS agencies were discussing and drafting regulations for the State Children's Health Insurance Program. The discussion was lively with much debate, particularly around the issue of standards of care for emergency room visits. 

As standards for ER wait times were proposed, I scanned the room. Most of the people were young, bright, and very accomplished in drafting regulations and legislation. Then I asked, "Who has ever worked in an emergency room?" The room grew quiet. "How many of you have ever provided care to a patient?" Aside from a staffer who was an LCSW and me, no one at the table had ever rendered care to a patient, much less in an emergency room. 

Too often the people developing rules and regulations that guide - and judge - what constitutes the "standard" of care are largely divorced from the practical world of doctors, nurses, therapists and other providers.  So if we want a different system of care, health care providers can't abdicate or ignore the leadership role they must play in shaping it.  

That's why Dr. Berwick's leadership at CMS is so pivotal. As a physician, he knows the Affordable Care Act (ACA) offers unprecedented opportunities for providers to exercise leadership in shaping how our health care system should change. For example, one part of federal health reform is the development of new payment models to Accountable Care Organizations (ACOs).  Primary care patient-centered medical homes are intended to be the backbone of most ACOs, yet, their development seems largely led by health system administrators whose first-hand knowledge of primary care practice is cursory at best. 

If ACOs are going to work, primary care providers need to step forward to ensure payment and revenues are aligned to support and sustain their "medical homes."  To do this, we need fewer MBAs and a lot more MDs, DOs, NPs and LCSWs leading the development of ACOs so they truly end up supporting a better primary care system.

At the September roundtable meeting, Dr. Berwick outlined his view of the ACA, noting in many ways it's like two laws. One component addresses justice by providing coverage for the uninsured.  He felt this part of the law speaks to the kind of nation we want to be. The second element gives us an opportunity to create a better system of care.

In Dr. Berwick's eyes the ACA is a "majestic" law, but it will take visionary leadership to fulfill its promise. He was answering that call to strengthen our society. Will you?

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