He’s got one of the most important healthcare positions in the country, with an annual budget of roughly $800 billion. As administrator for Centers for Medicare and Medicaid Services, Dr. Donald Berwick faces the sizable task of implementing many of President Barack Obama’s healthcare-reform measures.
It’s a role that’s been met with a few fits and starts, from the get-go. Back in July, sensing the winds of political brouhaha, Obama took a beeline past the normal confirmation process to tap Berwick through a recess appointment. That approach ensures that Berwick — a long-time healthcare leader who recently served as chief executive (and co-founder) of the nonprofit Institute for Healthcare Improvement — will serve out his term as CMS administrator until the end of the next congressional session without a Senate vote or hearing.
The question now is: Can Berwick help move beyond political wrangling to advance a stronger, more effective — and cost-efficient — CMS? Among other top agenda items, Berwick is tasked with cutting half a trillion dollars from Medicare. Can he do it?
Those questions won’t be easy to answer, especially as opponents continue to voice concerns. Charges of healthcare rationing have been leveled against Berwick. So have questions related to the finances of the Massachusetts-based nonprofit group he co-founded. Sen. Charles E. Grassley, a ranking member of the Senate Finance Committee, cites a potential for conflicts arising from donors to the Institute for Healthcare Improvement. The White House, in turn, stated the independent office of government ethics deemed Berwick in total compliance with all ethics and conflicts rules outlined by Congress.
Meanwhile, Berwick stands as the most powerful change agent in Medicare and Medicaid delivery — second only to U.S. Department of Health and Human Services Secretary Kathleen Sebelius. Top healthcare analysts have noted the new Patient Protection and Affordable Act pivots Berwick’s role as CMS administrator to new heights of importance.
Among those making that assessment is Avik Roy, a healthcare analyst at Monness, Crespi, Hardt & Co. in New York City. Recently, Roy told Health Care News, “PPACA mandates significant changes in Medicare and Medicaid that Berwick will be responsible for implementing. It’s the HHS secretary who has the most power, but the CMS administrator is second on that list.”
What’s Ahead: Industry Leaders Weigh In
So, what’s next for Berwick? What should his top priorities be? We recently took those questions to top healthcare IT leaders within government contracting. Here’s what they’re saying:
Amy King, vice president of health IT programs, Northrop Grumman Corporation:
“Dr. Berwick will be able to significantly foster the Centers for Medicare and Medicaid Services’ transition from ‘payer to player’ in improving healthcare quality for the nation. I expect that he will help transition CMS to utilizing more outcome-focused strategies that emphasize health and disease prevention while ensuring healthcare results — paying for care when it gives the best outcomes to each beneficiary. The ‘Triple Aim’ strategy (improving the patient-care experience, increasing the health of the population and reducing/controlling healthcare costs), as well as the identification of new models of care and the expansion of integrated delivery systems, will help achieve the goal of improved healthcare quality across the nation.
Industry could broadly assist him by: identifying appropriate models and quality measurement systems; facilitating the systemic adoption and dissemination of such models; and evaluating the efficiency and effectiveness of those models for widespread adoption. Undergirding these efforts will be the routine and effective use of robust and integrated data systems across all healthcare domains and functions. Through greater use of these systems, we can help break down information stovepipes and provide greater data sharing/transparency across agencies and healthcare systems at all levels. This will allow us to deliver higher-quality information to set and achieve enhanced standards of care, enable greater transparency of provider and facilities performance, streamline healthcare management and processes, better incentivize targeted access to the right care for the consumer, and ultimately, support better outcomes (at lower cost) to benefit patient care.
Industry has been a leader in the development and use of these data systems. We look forward to assisting CMS in developing and using them to help the agency achieve its goals for the nation.”
Larry Albert, healthcare sector president, Agilex Technologies, Inc:
“Don Berwick is tasked with implementing significant healthcare reform while continuing to ensure both the quality and timeliness of care for current beneficiaries. When successful, these initiatives – meaningful use, new financial models, and integration of comparative effectiveness research into clinical care – will dramatically improve healthcare delivery. This is critical to solving the sustainability crisis threatening both Medicaid and Medicare. The stakes are high as the digitization of medicine must improve the efficiency and effectiveness of healthcare delivery. Otherwise, we as a nation face a host of very serious challenges.
In terms of the industry, these initiatives will transform how we use information and data within healthcare. What’s needed are more robust information models, more granular capture and exchange of electronic health information, and more effective use and integration of analysis into care delivery.
Too often, clinicians tell us that solutions inhibit rather than enhance the practice of medicine. Greater sensitivity to clinical processes is needed, including additional flexibility regarding how solutions can be deployed and consumed. Instead of asking clinicians to change their behavior, we need to find ways to adapt our user interfaces, workflow and data models to their requirements.
While game-changing technology is on the horizon, accessibility remains an issue as well. In addition to upfront costs, we need to ensure that our solutions can be easily maintained. This is an area where industry can have a huge impact through our use of open source technologies and promotion of cloud computing options.”
Dr. Robert Wah, chief medical officer and vice president of CSC’s North American Public Sector business unit:
“As a fellow physician, I know Don will be seeking to improve the care and health of Medicare and Medicaid patients. Being a technology leader, I believe industry will help Dr. Berwick by using technology to improve healthcare with better information for better decisions by patients, doctors, government and private payers, and researchers. This will result in saving lives and money.”
Paul Nedzbala, vice president and director of health programs, SRA:
“Healthcare is perhaps unique as a service in that there is such a weak correlation between cost and quality, with the very best care often costing less than mediocre care. By driving quality and efficiency into delivery organizations — via standardizing care protocols, implementing checklists, and enabling clinicians and administrators to use IT to make information-driven decisions — Dr. Berwick has a historic opportunity to make a significant impact in two key areas: He could save America billions of dollars during his tenure and could improve the quality of life for tens of millions of our citizens.
To more rapidly initiate these programs, Dr. Berwick should consider tapping the intellectual resources and execution expertise of the private sector. For example, SRA alone has 1,300 professionals in health programs whose expertise includes comparative effectiveness, advanced analytics, logistics and enterprise resource planning, fraud detection, and telemedicine (to name but a few areas). For a quick win, Dr. Berwick should consider expanding CMS Program Integrity (Fraud, Waste, and Abuse) efforts forward in this fiscal year, and reprogram resultant savings into clinical quality improvement programs and electronic health record and related information systems, which together will yield long-term, durable results.”
Michael L. Cowan, M.D., FACP, director, Deloitte Federal Health, retired vice admiral, Medical Corps, U.S. Navy:
“Now that the Patient Protection and Affordable Care Act (P.L. 11-148) has passed, and the new administrator for the Center for Medicare and Medicaid Services, Dr. Donald Berwick is in office, the challenge of implementing the largest overhaul of our healthcare system since the 1910 Flexner Report can begin in earnest. Flexner famously reformed medical education, providing the basis of modern healthcare. But today’s challenge is far greater, as American medicine addresses nearly all aspects of itself, in a system much larger and more complex than Dr. Flexner could have imagined.
Complexity itself represents the biggest challenge to successful reform. In a recent book, “If We Can Put a Man on the Moon, Getting Big Things Done in Government,” Deloitte’s Bill Eggers and John O’Leary note that, “Everything is harder to do in government.” The challenge facing healthcare reformers is that our ‘health system’ is a chimera of private, public and governmental components, with no one in overall charge. The resulting hyper-complexity causes the system to inherently resist change.
As we look at the priorities for CMS and Dr. Berwick over the next 18 months, one can identify drivers that hold the keys to success. Prominent among these, industry wide adoption of efficient electronic information technologies is needed to provide effective information exchange, which is at the very core of all aspects of medical practice, management, and economics. IT adoption is a uniquely important priority because it enhances the effectiveness of most other vital aspects of reform. Unless the medical profession widely and fully deploys information tools, many desired improvements in cost and quality reforms will remain elusive.
CMS faces multiple challenges. Effective communication of information is paramount. Effective IT will be vital for success.”
Kerry Weems, senior vice president and general manager, health solutions, Vangent:
“Dr. Berwick is an excellent choice for CMS administrator. His background and stature in the healthcare community will be invaluable as he navigates the straits of the coming years. His top priority will be the implementation of healthcare reform. Implementation is manifest in many forms: regulations, policies, procurements, budgets and people. Each one of these has its own challenges and opportunities and its own unique set of stakeholders. Success will be measured by the seemingly incompatible goals of listening to the stakeholders, while driving hard to a conclusion.”