In this podcast interview, Don Berwick, Democratic candidate for Governor of Massachusetts and former head of the Centers for Medicare and Medicaid Services, discusses his views on healthcare with healthcare business consultant David E. Williams, president of the Health Business Group. This is the fifth in a series of nine in-depth interviews with the candidates. For a complete schedule and an explanation of the questions visit the intro post.
Excerpts from the interview are below. The full transcript is available here.
Question 1: Does Chapter 224 represent the right approach to addressing rising health care costs? If not, where does it miss the mark and what would you do differently?
“It’s directionally correct. It sets some goals for cost containment in the state. It encourages coordinated behavior among caregivers. It’s a step in the right direction. I am hopeful about it, but its major problems are that it’s primarily voluntary.”
“It may need more teeth. It’s so urgent to get healthcare costs under control in the Commonwealth without harming a hair on a patient’s head.”
“The state should pursue what, in my former role, I used to call the Triple Aim: better care, better health, and lower cost through improvements.”
“I’m the only gubernatorial candidate who has put single-payer as an option, potential option, for the state on the table. I would like to see us move very swiftly to understand whether and how we could move into a single-payer environment.”
Question 2: Certain provider systems in Massachusetts are reimbursed significantly more than others for the same services even though there are virtually no differences in quality. Does the state have a part to play in addressing these disparities?
“We need a lot more transparency about what these prices are set at, and more accountability for the systems that are charging significantly more. Then it has to be well-known to the public and payers. Purchasers of care need to be alert to that and help patients stay alert to it.”
Question 3: More than a dozen state agencies have a role in health care. Is there an opportunity to consolidate or rationalize them?
“One of my main goals [at CMS] was to rationalize the many, many different silos or compartments within the agency. Sometimes that has to be done structurally.”
“I’m in favor of extremely high levels of cooperation with agencies and if they don’t cooperate, then we have to consider restructuring.”
Question 4: Government policy has encouraged adoption of electronic medical records. However many providers complain about the systems and the benefits have been slow to materialize. Should state government play a role in helping to realize the promise of health information technology?
“Electronic records can play a big role in helping physicians and nurses. They also can be available to the patients. So it’s a very important step.”
“Federal leadership on information exchange and interfaces… has been very slow.”
“The new wave of so-called Meaningful Use requirements… will help places move more swiftly toward interface compatibility.”
“I’m encouraging relevant state agencies to get on board, and the providers of care to really adopt these new standards as fast as they possibly can.”
Question 5: Hepatitis C is 3 or 4 times more common than HIV. New drugs that can cure the infection are coming on the market this year but they are very expensive. What role should the state play in ensuring that residents are tested, linked to care, and have access to these new medications?
“I abhor the concept of rationing. I think there’s no way we should be withholding any effective treatments from patients.”
“Once we have in our hands technology that works, and is proven to work, we have to make sure it’s accessible to everybody.”
“We have to recover money from ineffective care, wasteful care, and harmful care. We need to work very hard to make sure that we have the resources liberated from health care waste, so we can rededicate them to things like proper Hepatitis C care.”
Question 6: There are multiple health care related ballot questions. What are your thoughts about them?
“I don’t think it’s a good idea to legislate ratios. I think what we should legislate is adequate care. I favor standards in the Commonwealth in which we absolutely guarantee that all patients have adequate nurse coverage at all times.”
“To put a specific ratio into legislation could be a mistake. It’s trying to do management with law and I think that’s a mistake and I fear that a ratio in law that’s intended to be an adequate number will soon become a ceiling.”
Question 7: What did you learn from running CMS that will be useful as Governor?
“I loved running CMS. It’s the largest agency by budget in the federal government, $800 billion. It’s 5,500 employees.”
“I know a lot about executive leadership for improvement in quality and excellence.”
“I set very high goals. I invited everybody to join as a single team.”
“[At CMS] I encouraged them to innovate in their jobs. So the workforce had the support from me to try new things. Even if they failed, we still learned. I emphasized customer focus.”
“We will work very hard on excellence and quality in operations of the state government, from top to bottom, end-to-end, and I will personally invest in that as I did in leading CMS. What I learned there is that it works in government just as it does in the private sector, if you’ve got a leader that understands that.”
Question 8: Much of the emphasis in health care reform is on adult patients. Is there a need for a specific focus on children’s health?
“The well-being of children poses a very exciting challenge, and one that the state ought to be embracing, which is to understand child well-being as a totality.”
“If you want to have a healthy child, you have to think systemically.”
“A healthy child isn’t just getting good healthcare. They also need a healthy environment. They need parents who have a secure role in the economy. They’re not being challenged by unsafe streets, or threats in the air, in the environment, or from pollution.”
“I’d love to foster a community-by-community endeavor in the entire Commonwealth on a voluntary basis. That’s involving every community to improve the well-being of every young child, in cooperation with families, and really assure a child’s readiness for school, good nutrition, and high self-esteem. I think we can do that in the Commonwealth.”
Question 9: Is there anything you’d like to add?
“I want to emphasize how excited I am about the possibility of bringing my skills in executive leadership and improvement into the leadership role of Governor. I’ve worked in large systems and I understand how to recruit energies of the workforce on behalf of the people who are served.”