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National Summit on Health Care Quality and Value

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Washington, DC
October 4, 2010

Thank you Peter for your kind introduction and for being our master of ceremonies today. Peter brings to the Office of Health Reform valuable experience with innovation in our delivery system from his time at the helm of the Pacific Business Group on Health.

Thank you as well to our colleagues on the Hill – members and staff – for their ongoing commitment to improving health care quality. Some of them are here with us today: Congresswoman Allyson Schwartz and later today, Congressman Ron Kind.

I look forward to continuing this important discussion with you all well into the future.

I also want to thank Sherry Glied, my Assistant Secretary for Planning and Evaluation and her staff for their hard work coordinating today’s Summit.

Sherry and Peter are part of our new leadership team doing great work at the Department of Health and Human Services.

And a few months ago, we welcomed another very talented colleague and long-time friend to our team when President Obama appointed Dr. Don Berwick to be administrator of the Centers for Medicare and Medicaid Services.

I don’t need to tell you – but I will – what a remarkable leader Don is. He is the kind of visionary who is always 5 steps ahead of everyone else. He sees the big picture and all of its parts and can explain them in a way that leaves us with clarity and purpose.

Dr. Berwick has worked on quality and care improvements with health care providers across the country for decades. And has already begun to make sure CMS is a leader in improving our health care system and becoming a value purchaser.

Now I want to thank everyone here today for participating. This Summit comes at a pivotal moment.

I came to HHS as a governor. I ran one of the largest health plans in our state for employees and their dependents, as well as our Medicaid and CHIP programs.

And I know that health care quality is directly connected to our economy and our productivity. It’s about industries that have the potential to drive growth and create jobs. It’s about community health and our long-term prosperity.

As the world keeps growing smaller and more connected, America needs a strategy to compete and succeed. But that can be hard to achieve when we spend 50 percent more on health care per capita than any other country in the world.

We have to do better: better health, better care, lower per capita costs.

Now, much of the discussion of the Affordable Care Act has been about insurance markets, consumer benefits, and coverage.

But the underlying bill truly is a platform for transforming the delivery of care.

At its very core, our work today is about improving lives and ensuring peace of mind. It’s about getting the right care to the right person at the right time -- each and every time.

At the Department of Health and Human Services, our responsibility is to be guided by science about what works and what doesn’t. But also, to closely examine those pockets of innovation across the country where we’ve seen the greatest success, and to give you the support to bring them to scale.

That’s why we’re all here today. Not to make a new discovery, but to make good on those discoveries we already have before us, and to put them to work.

We’re all here together under one roof to share ideas, so leaders from Maine can help Oregon solve its unique challenges, and so experts from Wisconsin can share their latest research with those in Massachusetts.

Health care is a national issue and we have to confront its challenges together, as a nation at every level.

Now, for the most part, we already know where we should be going -- toward a high-performing, patient-centered health care system built on the latest evidence, the most advanced technology, smart incentives, and a focus on keeping people healthy.

But as you know, getting there is the hardest part:

Because if you want providers to coordinate care, they need the tools and the incentives to connect.

If you want patients to make prevention a priority, they need the knowledge and the choices to stay healthy – long before they even get to the doctor’s office.

And if you want quality to improve, everyone needs the information to measure what works and what does not.

That’s why soon after the Obama Administration took office, we enacted the Recovery Act and began to build a platform for change.

We made an historic investment in prevention, providing grants to support some of the most promising and proven community strategies around the country for promoting wellness and reducing chronic disease – from serving healthier school lunches to designing more walkable neighborhoods.

We invested in our primary care workforce, expanding our national network of community health centers and providing new funds to train primary care doctors and nurses.

And we made the biggest investment ever in health information technology, because we know electronic health records can save money, slash paperwork and help doctors deliver better care.

All of these investments are rooted in the belief that confronting cost and quality are two sides of the same challenge.

This August marked a turning point, as major insurance companies, provider groups, doctors, hospitals and patients all came together to announce that they would team up to support our “meaningful use” regulations – guidelines that doctors and hospitals will have to follow to earn incentives for moving from paper to electronic medical files. Dramatic change isn’t going to happen overnight. But it is underway.

So we have a platform for change. Now, if we are serious about confronting the problems at the heart of our health care system, then we also need to change its incentives – so that doctors and hospitals are rewarded for delivering the kind of care we know works best.

Six months ago we enacted the Affordable Care Act, and one of its first changes is to provide every Medicare beneficiary with an annual wellness visit with their primary care doctor free of charge, starting in 2011.

This way, doctors and patients can create a plan to prevent illness or create a treatment plan that meets all of a beneficiary's health needs.

We’re building on the Recovery Act’s prevention investments and steadily shifting the focus of attention within our health care system from waiting for people to become acutely ill, to giving them access to care earlier, in a way that is more cost-effective and more health-effective.

But we must go further still to move our system from a volume purchaser to a value purchaser.

Today, one out of five Medicare patients who leaves a hospital is back within 30 days. Often, this is because patients don’t get the right follow-up care: they didn’t understand their doctor’s directions, they didn’t eat the right diet or take the right medicines or get the right wound care.

There are a lot of factors that may contribute to these complications, but we know that it often comes back to the way we pay our providers:

Right now we say to the hospitals, the surgeon, the anesthesiologist and everyone else on the patient’s health care team: “Here’s your payment for treating your part of the illness.”

In the process we’re providing the wrong incentive, and encouraging every provider to do their own thing without coordinating care or communicating about outcomes.

I know I don’t have to tell you that providers should be working together to keep their patients healthy.

And in fact, the vast majority of them do exactly that. But when they do, our system shouldn’t punish them for their time and planning. It should reward them.

So we’re funding demonstration projects to show how bundling payments can align incentives for the entire group of providers—from the hospital, to the primary care doctor, to the visiting nurse that provides follow-up care.

And we’re encouraging the development of "accountable care organizations" to better coordinate patient care and improve quality, help prevent disease and illness, and reduce unnecessary hospital admissions.

We’re going to take this concept nationwide in 2013, with a pilot program encouraging hospitals, doctors, and other providers to work together to improve the coordination and quality of patient care.

Of course, none of this is new. I know we’re building on years of study and progress.

It’s been a decade since the Institute of Medicine’s groundbreaking reports To Err is Human and Crossing the Quality Chasm. They opened many people’s eyes – policy makers in particular – and shined the light of day on what had become a truly national crisis.

Slowly, we have begun to see quality improvements take hold, some broadly across the entire health care system such as techniques to reduce waiting-room time, ensure heart attack patients take the right medications, and prevent hospital acquired infections.

When hospitals in Michigan used a new approach to cut infections by 66 percent, they reduced costs by $200 million, and saved more than 1,500 lives in just 18 months. The dramatic improvement did not require investment in new equipment or additional personnel. The essential thing was focused leadership and a commitment to following the protocol each and every time.

We’re taking that recommended checklist far and wide. And there’s no reason why it shouldn’t be implemented in every hospital room in the country. So we’re making the investments to encourage hospitals to do what has been proven to work.

Sadly, there is still a 17-year lag, on average, between the discovery of effective treatments and their incorporation into routine patient care.

That’s simply unacceptable – the best ideas and latest innovations mean nothing, if they’re not being put to use.

So we’re establishing a new Center for Medicare and Medicaid Innovation which will be tasked with identifying and testing promising new models for delivering and paying for health care. But just as importantly, sharing and disseminating those ideas.

The Center will be looking at promising models, like patient-centered medical homes tailored to patients' individual needs and of course, efforts to promote more coordinated care.

Dr. Richard Gilfillan – former President of the Geisinger Health Plan and currently at CMS – will be leading our efforts in the Center for Innovation – another good example of how we’re giving important tools to experts who have already made these reforms in the real world, so they can help us take them to the next level.

Most of the models we’re trying to promote don’t need to be invented. They’re already being tested and used in communities across the country, making a real impact on people’s lives. So we will continue to rely on your expertise to help us identify what works and why. We’re eager to be informed by your experience and to work with you to encourage medical care that saves lives and lowers costs.

We have a lot hard work still to do. At times, the challenges we are discussing today may seem insurmountable. We have been talking about quality for a long time and our system still costs too much while delivering far too little.

Yet, we’re seeing progress, renewed transparency, a change of priorities and new attention to high-quality care. Slowly consumers are becoming better informed. Providers are using better techniques. And those who pay for care are beginning to reward value over volume.

In this moment, we have an opportunity. Together, we can take what works, build on that foundation, and bring quality care to every American, everywhere.