Jim Tallon: A New York Take on Global Challenges
In a recent meeting with health care leaders from a number of industrial nations—nations whose health care systems, indeed underlying philosophies, ranged from market orientation through hybrids to government authority—a number of common themes emerged.
The industrial world, participants observed, faces slower economic growth over the coming decades, distributed more broadly across the globe than in the past. Aging populations in virtually all our societies, even the generally younger U.S., will be moving away from participating in the “productive” economy and toward consuming more of the health and human services they will need. And long-term public and private debt, the focus of headlines in Europe and part of an ongoing debate in the U.S., will be, to some degree, omnipresent.
Health care costs, they concluded, especially in the U.S., will inevitably face increasing, unrelenting pressure in the years ahead.
But our conversations, while deeply challenging, also carried notes of optimism. Whether health care is organized with more influence from government or around private markets, all agreed that “bottom-up integration,” as I discussed in my last Blueprint column, is taking hold. Across the industrialized world, people are coming up with fresh ideas and vital approaches to the profound, central challenge that health care constitutes—new ideas on organization, financing, and care, on far greater use of real-time information technology, and on patients’ greater engagement in their health.
We’re in a period of active change. Just this year, New York has undertaken a substantial set of reforms, changing the very vision of Medicaid from a program dependent on fee-for-service care and payment to one based, for all patients, on care management. Virtually a week does not pass without the announcement, by Albany or Washington, of new innovative projects, whether patient-centered medical homes, health homes, or affordable care organizations. And more change lies ahead.
What were these leaders’ “keeps me awake at night” concerns? Their answer, almost uniformly, was that the pace of innovative change would not overtake the financial imperative to slash spending.
The challenge within the challenge, then, is how to take individual ideas and models to scale. With considerable consensus on the problems, and individual projects being implemented—whether generated in local communities or institutions or stimulated by government or private-sector support—we are now at a critical juncture: can the ideas that are being tested ultimately alter economic and societal trends, in which health care plays a major role? How do individual ideas, even the sum of those individual ideas, expand into systemic change that ultimately can get us the health care system we need, accessible for all, of the highest quality, and—the biggest challenge—actively altering the constant upward movement of the cost curve?
International experience and insights suggest several steps for us in the U.S. to take. The first is to be explicit about stating our common vision for an effective health care system—even when that vision challenges a tenuous status quo.
Second is to demand the highest possible level of quality, recognizing that continuous improvement efforts are fundamental to all quality activity. We’ll never know if we are winning the game unless we can effectively keep score: consensus standards and performance measurements are critical to moving individual experiences to a broader plane.
Third, innovators need the opportunity to collaborate with each other. The real impact of such efforts, whether new approaches to delivering primary care, team-based care in organizations, incentive-based payments, or other means of meeting challenges in a less costly, more effective way, will emerge from the active interaction of those at the front edge of innovation.
Finally, we need to understand how those goals can be met within reasonable time frames—through requirement or incentive, mandate or consensus—and we need them to be adopted by the entire health care system.
A vision, a disciplined system of measurement, collaboration among innovators, and, ultimately, the adoption of broadly based standards and policies: these are the elements in converting good examples into a health care system capable of withstanding the pressures ahead.