Dr. Donald Berwick, a leader for the times

Dr. Donald Berwick, the new head of CMS

President Obama appointed Dr. Donald Berwick to head the Centers for Medicare and Medicaid Services (CMS) this week.

The decision was lauded by the New York Times. “Dr. Berwick’s major credential for the job is that he leads the Institute for Healthcare Improvement, (IHI) a consulting group that promotes measures to improve the quality and safety of health care while reducing its costs. He has been enormously successful at getting health care professionals and institutions to work together to reform their practices — exactly what the agency needs.” (New York Times Editorial, July 7, 2010.)

I would suggest that inherent in Dr. Berwick’s credentials for the job of getting health care professionals and institutions to work together for reform is leadership.

Leadership is what is needed to take on the health care crisis in the nation. So let’s look at the substance and content of Dr. Berwick’s leadership. Let’s do it in the context of some facts:

• If we continue to spend at the current rate, by the year 2040, health care spending will rise to 30% of Gross Domestic Product (GDP) compared with 17% today. That’s at least twice what any other nation in the world spends!
• Since 45% of health care spending is funded by the government, at the current rate of growth, it will require 70% of income taxes to pay for these expenditures by mid-century.
• Today, health care spending takes nearly 25% of a family’s income.  By 2020 these costs could double at current annual increase in costs.

The challenges

What do these facts mean?

They mean that after many decades of inaction, the nation has placed its population at great risk. This kind of spending on health care crowds out wage increases, savings, investment, and economic growth and expansion needed to rebuild the nation’s social and manufacturing infrastructure.

They also mean that the health of the population suffers. Although the U.S. spends more of its resources on health care that any nation in the world, it ranks at the bottom of the industrialized world on health outcomes.

And let’s remember that these worst outcomes in the industrialized world are even worse for our sisters and brothers who are African-American, Latino, and Native-American.

Don Berwick is a pediatrician and a Harvard professor. His manner is mild and kind. He is a great listener. He is the classic “healer.” He also is a powerful voice:

Listen to what he says:  “We must have courage to achieve success.

The courage to aim high.

The courage to search outside.

The courage to compare.

The courage to trust the workforce.

The courage to trust the patients.

The courage to test change and make mid-course correction.

The courage to ask ‘What am I a part of ?’”

For Dr. Berwick and IHI, success is defined as the Triple Aim:

• Improve the health of the population
• Enhance the patient’s experience of care
• Reduce or control the per capita cost of care

The Triple Aim is much like Kaiser Permanente’s Value Compass. We look at the whole, we look at the system. We recognize that quality, service, affordability, making KP the best place to work and keeping patient needs at the center of all we do are one cohesive aim -- a balanced approach that recognizes that all components of the system are at work at all times, and we must recognize the interactions if we really want to achieve success.

Dr. Berwick will now head up CMS, the federal agency that oversees the expenditure of about $850 billion annually, or about 37% of all health care spending in the U.S. It is his leadership around courage, the Triple Aim, and placing the economics and science of health care reform into a moral duty that will show the nation that success is finally possible.