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Columbia School of Public Health Commencement

New York, NY
October 15, 2010

Thank you, Dean Fried, for that nice introduction and for inviting me to be here today.

As Secretary of Health and Human Services, I’m surrounded by Columbia School of Public Health alumni. Every day, I work closely with former Mailman students and professors, whether it’s our terrific CDC Director Tom Frieden or our superb FDA Commissioner Peggy Hamburg.

As most of you know, earlier this year, we were fortunate enough to lure Sherry Glied down to Washington to serve as our Assistant Secretary for Planning and Evaluation and advise me in all areas of health and human services policy.

So I had to make a deal with Dr. Fried: if I came here to speak I wouldn’t take any more of her faculty members with me when I left. (At least not right away).

This is a special school, and the Executive Masters program is a special program. You have already established yourselves in your careers, whether it’s caring for patients, managing a clinic, developing new medicines, or in some other health profession.

No one forced you to give up four days a month, get used to doing homework again, or study accounting.

But many of you came to this program because you weren’t satisfied with personal success. You wanted to make a bigger difference: to use your skills and experience to help more people, to change more lives.

That took an unusual level of dedication on your part. It also took a lot of patience on the part of your families: whether it was parents who supported you, spouses who made dinner while you studied, or children who taught you how to download podcasts so you could listen to your lectures.

So before I go any further, I’d like to take a moment to recognize all the family members in the audience.

It’s a pleasure to be here with you for this important milestone in your careers. But if you’re going to dedicate those careers to improving health and health care in America, as I hope you will, I have to warn you now: there is a lot of work to do.

By now, you understand the challenges we face better than anyone.

There are more than 50 million people in America today who have no health insurance, putting them just a car accident away from going bankrupt. The share of children who are overweight has quadrupled in the last 40 years. And while we lead the world in medical research, medical care, and health care spending, we don’t even come close to leading the world in health. By some measures, like how long we live, we’re not even in the top 25, behind countries like Bosnia and Jordan.

Because our health care system is so vast, it can be easy to feel overwhelmed by these inefficiencies and shortcomings. Trying to improve safety and quality can feel like climbing a very tall mountain: it’s hard to tell when you’re making progress, the summit never seems to get any closer, and the temptation to give up and turn around is strong.

But the fact that you’re here today tells me that you’re still optimistic. And that’s good because I also have some positive news for you this afternoon: there’s never been more opportunity to improve our health care system than there is today.

I’m not just talking about recent legislation. It’s true that this Administration has taken some big steps forward on health in the last two years – from the Affordable Care Act, which will give every American access to affordable health insurance, to the Recovery Act, which made historic investments in prevention, electronic health records, and our health care workforce, to the First Lady’s Let’s Move campaign, which is bringing together partners across the country to help children make healthier choices.

But we’re also seeing signs of progress across the country. When I started working on these issues twenty years ago, many of the solutions we were talking about were hypothetical. There was agreement that we needed to put a bigger focus on prevention, that it was important to help doctors work more closely together, that we needed to change incentives for health care providers, that it would b helpful to have better data on health outcomes. But we didn’t have a lot of models for how to make these changes.

Today, that’s changing. Last week, our department hosted a national summit on health care quality and value. We heard from providers who have improved care and reduced costs using medical home models and slashed readmission rates by providing better follow-up care. We heard from one hospital system that had gone over a year without a central line infection.

So you’re leaving Columbia with your new degree at a time of great potential. We have better models than ever before for how to deliver high-quality health care at a reasonable price. The challenge for you will be to help these promising models and innovative approaches spread. And that’s what I want to focus on today.

Our Department’s Agency for Healthcare Research and Quality, has done research which shows that it takes 17 years from the discovery of an effective treatment for it to be incorporated into routine patient care. Across our health care system, we see these same lags over and over again.

The best ideas from Maine don’t always make it to Oregon. Sometimes, they don’t even make it to the next town over or to the adjacent wing of a hospital. That means our job is often not to invent something new, but to figure out how to make an innovation we already have work in a new setting or a different community or on a broader scale. And sometimes, the details make all the difference.

I’ll give you a few examples.

One of the panelists at our summit last week was from the Geisinger Health System, a well-known, high-performing hospital system in northeastern Pennsylvania. They were asked: “what was your “aha” moment when it came to delivering higher quality care?”

In their answer, they talked about a program they started to follow up on patients who were suffering from congestive heart failure and were at high-risk of being re-hospitalized.

When they started the program, they had all the case managers in a remote call center. The problem was, only ten percent of the patients would respond to their calls.

So they made a crucial change. They moved the case managers to the hospitals where patients were receiving care. That way they could actually meet the patients’ families and develop relationships. And that made people much more likely to take their calls and listen to their advice late on.

That small change made all the difference.

Here’s another example some of you may be familiar with: every year, tens of thousands of Americans die from the infections they get in hospitals. That’s more than die from homicides and car accidents combined.

We’ve known for years that many of these infections can be prevented with basic steps like washing your hands with soap and wearing a sterile mask. But there are ninety thousand Americans in intensive care units every day. Mistakes happen.

As some of you may know, the most effective tool that’s been invented for preventing these unnecessary deaths is not a fancy new treatment or instrument. It’s a checklist that reminds health care providers to take basic safety steps when inserting a central line.

This checklist was developed by a doctor at Johns Hopkins, and when our department helped bring it to Michigan, they were able to reduce infections by 66%, save over 1,500 lives, and bring down costs by $200 million in just 18 months.

Again, the details made all the difference. Just creating the checklist wasn’t enough. It was only when hospital administrators gave the checklist to nurses and empowered them to step in if it wasn’t being followed that infections plunged. When we get the details right, we know we can improve health safety, lower costs, and save lives.

This same principle applies when it comes to the health decisions we make outside the doctor’s office or hospital room.

For example, we know that one of the biggest keys to staying healthy is eating a nutritious diet. And we also know there are lots of obstacles to doing that, from neighborhoods with no grocery stores to the lack of nutrition in some school meals.

But one of the biggest obstacles to eating healthy is knowing which foods are healthiest.

We all know that fresh fruits and vegetables are better than French fries. But how many of us would guess that a tuna melt sub at a fast food chain can have more fat than a stick of butter? Or that an individual pizza at some restaurants can have as much fat as 45 sticks of bacon?

Of course, you could find this out if you were willing to go to a website and read through pages of numbers in a tiny font. But a better approach is to put that information right on the menu where customers can make easy comparisons.

And as part of the Affordable Care Act, we’re going to make sure that many restaurants do just that.

What all these examples have in common is they recognize that underneath all the statistics about our health care system are human beings. They’re human beings that almost always want to do the right thing – to eat the right diet, to deliver the best care, to follow their doctor’s instructions. But these are not always easy things to do.

So a big part of improving health in America is taking small steps that make it easier for patients, doctors, and everyone else to do the right thing.

This is a priority for our Administration. To give you one last example, one of the most important parts of the health care law is actually a new consumer website we created called

Thanks to this site, Americans can see all their insurance options in one place for the first time ever with information about pricing and benefits.

Not only does this make the process of buying insurance easier for consumers, it also creates a more competitive market. It’s a lot harder to charge an exorbitant premium when your competitor’s price is right there below yours.

We are going to keep pursuing these opportunities to empower consumers, patients, and doctors, but we need your help.

I believe this class of graduates has the unique skills and experience to lead this kind of change. You have just received an expert education in the big picture of our health care system. But you have seen it through the lens of your real world experiences on the front lines of our health care system.

If you can combine these two perspectives – a broad knowledge of the challenges in our health care system and a deep understanding of the barriers that doctors and patients face every day – you will be the leaders who seize this historic opportunity to transform health care in the US. There is no more important work you can do for your communities or your country.

But there will be time to transform our health care system later. For now, I hope you will enjoy the evening with your families. Congratulations on your graduation!