Exemplars Everywhere

April 10, 2013
In a conversation with senior clinical executives of Premier health alliance member organizations earlier this month, one thing was incontestably clear: the leaders of the truly pioneering patient care organizations nationwide simply aren’t waiting for Washington to tell them what to do to remake healthcare.

The French have a term for it: “l’air du temps.” The Germans have their own word: “Zeitgeist.” Both mean the spirit of the times--the current societal atmosphere, or "what's in the air." We tend to use these foreign terms because they’re so apt, and we don’t have an exact word or phrase in English that matches them.

In both cases, the idea is that different periods of history involve distinctive social environments in different places. Right now, I’d say that the “Zeitgeist” (which literally means “time spirit” or “spirit of the times”) in healthcare in the U.S. is certainly one of great ferment and opportunity, along with a nervousness about risk and reward, insofar as healthcare reimbursement goes.

Of course, it doesn’t help that there’s great uncertainty about what might happen next Monday, when the Supreme Court is expected to hand down a ruling in the legal case around the Affordable Care Act. But the reality, as everyone I’ve talked to in the past year who could even remotely be considered a healthcare industry expert agrees, is that our current healthcare system is unsustainable in terms of cost and efficiency, and fundamental “internal reform”—that is to say, physicians, hospitals, and other providers changing their ways—is inevitable.

What needs to be done, everyone broadly agrees, is for the healthcare delivery system to move towards greater transparency and accountability, and for providers to improve the patient safety, care quality, cost-effectiveness, and efficiency of patient care. Of course, the devil is in the details, as the old saying goes, and exactly how to achieve those broad aims has long been the subject of great contention.

Here’s the thing, though: in contrast to even five years ago—arguably, even three years ago—medical groups, hospitals, and health systems are moving forward, sometimes in collaboration with health plans, and sometimes purely on their own—do begin to put into place the foundations for the new healthcare. My own personal opinion is that the passage of comprehensive federal healthcare reform has been a major spur to innovation; I further believe that even if the ACA is struck down by the Supreme Court, the core elements of “internal healthcare reform”—the shift towards value-based purchasing, and the emergence of accountable care organizations, bundled payment contracts, and a broad range of quality improvement efforts—will continue unabated. Certainly, many of these “reforms” are already taking place through private-sector efforts, regardless of what happens specifically on Capitol Hill, though everyone also agrees that the reimbursement system must shift incentives away from wasteful fee-for-service paradigms and towards new-healthcare ones.

What’s incredibly heartening in all this is to see how the leaders of a number of pioneering patient care organizations are simply not waiting for direct orders from Washington, D.C. or anywhere else to move forward; they’re creating change on their own, and they’ve already got great gains to show from it. Indeed, the breakthroughs being created in some of these organizations are absolutely torpedoing all the all old excuses about why physicians and hospitals can’t improve patient care and operational performance.

Not surprisingly, the word “breakthroughs” is built into the name of the “Breakthroughs Conference” that the Premier health alliance has successfully put on for several years now. I can’t say enough good things about the kinds of healthcare system change that the Premier folks have been stimulating and supporting, through a variety of collaborative among their member organizations, and have been showcasing at their conference. I was able to attend in person a few years ago, and though I wasn’t able to participate this year, the Premier folks put together a panel of chief medical and quality officers for me, some of them presenter’s at this year’s conference, and I spoke with them by phone while they were in Nashville for the Breakthroughs Conference earlier this month.

Talking with Drs. Evan Benjamin, Greg Wise, and Douglas Bechard, of Baystate Health, Kettering Medical Center, and Adventist Health System, respectively—was inspiring and encouraging. These clinician leaders have no intention of being left behind in the push towards the new healthcare; instead, they are working closely with colleagues across their integrated systems, leading a variety of initiatives to create bundled payment arrangements, infuse evidence-based medicine principles into physician ordering, revolutionize physician documentation, and more. Gathered with them in a conference room for that discussion was Dr. Richard Bankowitz, who as enterprise-wide chief medical officer at Premier, has been helping to lead Premier’s huge breakthrough programs, including the QUEST quality improvement program, and others.

Listening to these leaders talk—always in very vision-inspired, mission-driven ways—about what they and their colleagues are doing to make healthcare better now, reinforced for me once again that we have the ideas and solutions at hand to remake healthcare, something we as a society absolutely need to do. The only question is whether the senior leaders of every patient care organization across the country will take up the cause of an improved healthcare system and do what’s right, as terrifically hard as it will be to do so.  But let’s face it: regardless of what specific things happen in the judicial, legislative, and executive branches of the federal government, our current healthcare system is unsustainable in terms of cost and quality, and the sooner that provider leaders move to remake the system, the better for healthcare—and for our whole society.

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