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Institute for Healthcare Improvement: National Forum

Orlando, Florida
December 7, 2010

Remarks for Secretary Kathleen Sebelius

Thank you, Maureen, for that very kind introduction. I am delighted to be here.

For the last 20 years, the Institute for Healthcare Improvement has played an indispensable role in improving health care around the world.

What started as a campaign to raise awareness has in two short decades become a powerful platform for new ideas that continue to lead to improvements in health care.

I also want to thank you for sharing Don Berwick with us.

I was thrilled when President Obama chose Don to lead the Centers for Medicare & Medicaid Services. I got to know Don in the mid-90s when I was Kansas Insurance Commissioner and we both served on President Clinton’s Advisory Commission on Consumer Protection and Quality in the Health Care Industry.

Just to give you an idea of how far we have come, you can actually find an archived press release from May 1997 with the headline: “President's Advisory Commission Unveils its Home Page.” (That was pretty exciting at the time.)

That commission also drafted a Patients’ Bill of Rights that was adopted by almost every state and now is federal law thanks to the Affordable Care Act. And with Don’s leadership, we drew up a blueprint for how to improve the quality of care systemwide.

Those changes have taken longer to implement than we hoped at the time. But I believe we now have real momentum behind a national movement to improve the care for patients in all settings of care, in all parts of the country.

It is wonderful to be working with Don again, focusing on these same priorities. Any time you can take one of the most innovative thinkers in an area, put them in the position of greatest influence, and give them a new platform for change, you have a chance to make a huge difference.

I know that for many of you it may have been tough to see Don go. But being here today, it’s clear that this Institute has not lost its stride. That reflects the terrific leadership of Maureen and the Members of the Institute’s Board. But it also reflects the power of your ideas and the passion of the people committed to making them work in hospitals and health centers around the globe.

We need that passion more than ever today because this is a pivotal moment.

Over the last 8 months, much of the discussion of the Affordable Care Act has been about insurance markets, consumer benefits, and coverage. We have been setting the groundrules for a new competitive private insurance market that will begin in 2014. And we have made real progress.

But reform is not just about insurance. The law is also a serious platform for improving the quality of health care and changing the delivery system so we stop doing things that don’t work for patients and starting doing things which do work.

It’s about better care: care that is safe, timely, effective, efficient, equitable, and patient-centered.

And it’s also, more broadly, about better health: We shouldn’t be waiting for health problems to show up to act. We should be trying to prevent these problems by giving people better access to preventive services including immunizations and cancer screenings. And we need to give everyone the tools to make the smartest, healthiest choices about their diet, physical activity, and environment.

Finally it’s about affordability. Rising health care costs are putting a bigger and bigger burden on families, businesses, and government at every level. Health care costs are the single biggest contributor to our underlying budget deficit in Washington, and they are often at the center of any debate in states about how to balance their budgets in these tough economic times.

These priorities are at the heart of the first-ever National Health Care Quality Strategy and Plan that we are developing now. We released a draft for comments this fall and have received a tremendous response. In January, the final version we release will be much stronger because of all the input we’ve gotten.

We need your participation because these are not abstract challenges.

As the world keeps growing smaller and more connected, America needs a strategy to compete and succeed.

But that is hard to achieve when we spend 50 percent more on health care per capita than any other country in the world, when one in three children and two in three adults are overweight or obese, when experts say we may have the first generation of children with shorter lifespans then their parents.

Today, we pay a lot of money for a system that rewards care delivered piece-by-piece, instead of in a seamless, coordinated manner. Some Americans get extraordinary care. But quality varies widely, and far too many of our health care dollars go to pay for unnecessary treatments and overhead costs.

Too many patients are hurt or killed because of adverse events that occur in the nation’s hospitals. Nearly 2 million Americans develop hospital acquired infections each year, which contribute to 99,000 deaths and as much as $33 billion in health care costs.

At the same time, a whopping 30 percent of health care spending—nearly $700 billion a year—is for services that may not improve people’s health. One in four heart attack patients and one in five heart failure patients are back in the hospital within 30 days of leaving the hospital.

This is expensive. But we can’t forget that there’s a human cost too. No one wants to spend more time in the hospital. Or watch their loved one pass away, not because of the illness that brought them to the hospital, but because of an infection they got once they were there.

Over the last decade, we have made progress. Campaigns like your Institute’s 100,000 Lives Campaign have brought new tools to providers. Slowly, we have begun to see quality improvements take hold across our health care system, such as techniques to reduce waiting-room time and ensure heart attack patients get the right medications.

Not long after I took office, we announced $17 million in funds from the Agency for Healthcare Research and Quality to help accelerate and expand proven approaches to reducing hospital-acquired infections.

And last week, the Leapfrog Group, a coalition of public and private purchasers of employee health coverage, announced that 65 hospitals participating in its annual survey have been recognized for best performance in patient safety and quality – more than ever before.

But as you know, not all the news is sunny. Research recently published in the New England Journal of Medicine and by our own Inspector General at HHS about patient safety makes it clear that we have a long way to go.

You see these trends everyday in the faces of your patients or the numbers at the bottom line of your budget. And you would not be here today if you did not believe that every one of us has a role and a responsibility in improving care and the way it is delivered.

For many years, the Institute for Health Care Improvement and its partners have been leading the way by developing, testing, and supporting innovations to make care safer and more patient-centered.

Yet despite your success, it’s been difficult to bring these models to scale. Our health care system remains fragmented and disorganized. Even the strongest private sector plans don’t have the reach to bring on wholesale change. And until now, the public sector has been slow to act. In fact, in many ways our public programs are operating in the 20th century while much of the private sector is using 21st century technology and innovation to drive change.

Thanks to the Affordable Care Act, this is changing.

We recently announced the creation of the CMS Innovation Center, an important new effort to stretch the boundaries of the existing systems of payment and care delivery to find new ways to improve the quality and affordability of care. While the center will be focused on Medicare and Medicaid, the combined purchasing power of those two programs will help the rest of the American health care system improve at the same time. And we are also making sure these efforts align with those of States and private payers.

The health care law provides $10 billion in funds to the Innovation Center: This is already appropriated. And it is available to be invested to carry out the Center’s important work over the next 10 years. If the strategies we test are proven to be more effective at improving quality, while lowering costs or remaining cost neutral, we have an opportunity to take the best ideas to scale in the Medicare and Medicaid programs.

The Center is already getting busy. We launched four new initiatives that we hope will have early results.

In eight states, Medicare will join with private plans and State Medicaid programs to participate in a demonstration project including as many as 1,200 medical homes. The Innovation Center will help to evaluate the effectiveness of doctors and other health professionals providing integrated care to up to one million Medicare beneficiaries.

Since some of the greatest care and cost challenges are with vulnerable populations, the Innovation Center will also support the launch of the Medicaid Health Home State Plan Option which allows Medicaid beneficiaries with chronic conditions to designate a provider as a “health home” to help coordinate treatments.

A third project will look at how we can provide patient-centered, coordinated care to treat low-income patients at as many as 500 Federally Qualified Health Centers.

And a fourth will focus on improving quality and care coordination for Dual Eligibles – those Americans who qualify for both Medicare and Medicaid.

We’ve hit the ground running, testing a host of delivery system reforms, because we know that innovation can happen everywhere from small, rural physician practices to urban, federally-qualified health centers in both the public and private sectors. We want to find the best models, wherever they are, and help them spread.

So what does Affordable Care Act mean at the end of the day? When all of these reforms are implemented and we make that shift in earnest from being a volume purchaser to a value purchaser, what will it mean in the lives of the people we want to help?

For a patient recovering from a heart attack, it would mean that when he gets home from the hospital, he’s more likely to have help from a care manager who knows his case, has access to his records, and can help him review his discharge instructions or refill his prescriptions.

His health is more likely to improve and he is more likely to stay out of the hospital.

For the doctor who treated that patient, it means she would have access to the latest research. She would be rewarded for providing the care that achieves the best outcome not the care that lends itself to the most procedures. And she will have an incentive to make sure her patient doesn’t fall through the cracks when she discharges him from the hospital.

She and her team will engage the patient in his own care and treatment.

For the hospital where our patient received his care, the health care law means new tools and new resources to measure what it achieves for patients and communities. The hospital will have an incentive to help its patients avoid readmission. And it will track outcomes over time, to learn how to do better and better.

The hospital will be transparent about its successes, its failures, and its progress, including its costs.

For all of the stakeholders, public and private, the law means the support to work together not just to coordinate care, but to align payment policies and public policy.

These changes won’t happen overnight, but if the Institute for Healthcare Improvement’s 20 year history is proof of anything, it is that good ideas are impossible to keep down.

I want to close by asking you to keep doing what you’re doing – keep pushing the boundaries, keep implementing innovative solutions to our health care challenges, and finding new ways to work together. And I want to ask you to partner with us to expand these efforts to create a truly national movement.

For decades, providers and patients, hospitals, community health centers, employers, insurers, and administrators, have been searching for ways to improve care and lower costs.

Now, we have a new toolkit at our disposal in the Affordable Care Act.

But government cannot solve these problems alone and neither can the private sector. That’s why in the coming months and years, we’ll continue talking to health care professionals, experts, employers, and consumers about how we can team up to move forward towards a 21st century health care system that keeps people healthier while keeping down costs.

We have made progress and saved lives. But we have a long way to go. And I look forward to getting there together.

Thank you.