January 13, 2011
Remarks as prepared for delivery
Thank you, Donna, for that very kind introduction.
At the Department of Health and Human Services, we are grateful every day for the extraordinary legacy Donna left behind. Whether we’re working to strengthen our defenses against bioterrorism, battling infectious disease around the world, or securing Medicare for future generations, almost everything we do is building on a foundation that Donna laid.
When Donna left our Department, she could have done anything, and I think it’s telling that she chose to continue her career of service at this great university. And I know the students, faculty, and community here feel very fortunate that she decided to “take her talents to South Beach.”
When Donna told me the theme of this forum was “defining the future of health care,” I was eager to come because I believe that future looks brighter today than it has in several decades.
In the last two years, Congress has passed more important health legislation than any time since Medicare. Everyone knows the new health reform law, the Affordable Care Act. But in the last 24 months alone, Congress has also passed historic laws to expand health insurance for children, reduce and regulate tobacco use, jumpstart the adoption of electronic health records, promote healthier lifestyles, and strengthen our health care workforce.
We also have made the single largest increase in scientific research in American history, begun a nationwide expansion of community health centers, and provided critical new resources to the Indian Health Services.
At the same time, we’ve seen stronger partnerships come together behind improving health care. While I know it may not be apparent from watching TV, there is a lot of agreement about moving in a new direction.
The new law, for example, passed with unprecedented support from the business and health care communities, including some organizations that had previously opposed reform. Part of the reason why is that the bill incorporates many of the best ideas for improving quality and lowering costs directly from employers and health systems around the country.
While differences remain, I’ve never seen so much momentum for improving health care in this country. And that’s not surprising when you consider the alternative.
Despite having the world’s finest doctors, best hospitals, and most advanced health technologies, America continues to lag behind in health results.
We know that part of the problem is lifestyle. Too many Americans don’t eat a healthy diet or get enough exercise. Too many people still smoke, even though the latest research shows that even a single puff can be dangerous.
But we also know that our problems don’t stop when Americans walk into a hospital or doctor’s office.
More Americans die every year from the infections they get in hospitals than from car accidents and homicides combined. And according to one recent report, one out of seven Medicare beneficiaries who go to the hospital is harmed as a result of the care they receive, not the illness they have.
What this means for Americans is simple. We live sicker and die younger than we should. We have more pain and discomfort and less ability to do our jobs, volunteer in our neighborhoods, play with our children. Too few of us get to watch our grandchildren grow up.
Bad health has huge costs for our economy too. According to one recent estimate, poor-quality care leads to as many as 45 million avoidable sick days – the equivalent of 180,000 full-time employees calling in sick every day for a full year.
At the same time, the skyrocketing cost of care puts an enormous burden on America’s families, state and federal budgets, and companies’ balance sheets – and puts Americans businesses at a serious disadvantage in a global economy. Last year, Warren Buffett called rising health care costs the “tape worm” eating America’s competitiveness.
When you look at this big picture view of our health care system, the challenges we face can seem insurmountable. Yet we know there are snapshots of success across the country
Over the last two years, I’ve visited neighborhoods that are improving health by serving healthier school lunches, met with employers who are bringing down health costs with onsite health clinics, and toured hospitals that are showing it’s possible to improve patient outcomes.
When our Department hosted a National Summit on Health Care Quality and Value last October, it drew health leaders from across the country who have cut costs, slashed readmission rates, improved coordination between providers, and in one case, gone over a year without a certain, common health care error.
We know a better health care system is possible because it exists; now it’s just scattered in pockets of excellence across the country.
The problem is that these best practices have been have been slow to spread.
In Michigan, a coalition of hospitals was able to cut central line infections by two thirds, reduce health care costs by $200 million, and save 1,500 lives in 18 months just by using a simple checklist that reminded doctors to take simple steps like washing their hands. If you heard that without knowing anything about health care, you might assume that hospitals across the country would be rushing to adopt this protocol.
But that hasn’t happened. And that’s where the federal government comes in.
I admit that government has often lagged behind the private sector and academia as a leader in promoting better quality in health care. Yet there is no doubt that we have an unparalleled ability to accelerate change, whether it’s by sharing best practices, making targeted investments, or creating incentives through the purchasing power of Medicare and Medicaid.
It was only when Medicare stopped paying for so-called “never-events,” for example – the medical errors that should never happen, like operating on the wrong body part – that other payers stopped paying for these too.
When government puts its support behind these efforts, improvements in health can speed up dramatically.
And that’s exactly what we’ve tried to do over the last two years.
As part of the Recovery Act, we’ve identified some of the most promising local strategies around the country for reducing obesity and tobacco use. They range from bringing farmers markets to underserved communities to expanding access to trails, bike paths, and parks so people can exercise more.
Communities received grants, and we’re following up to measure the results. Eventually, we hope the grantees with the best outcomes will become models for the rest of the country. So if you’re a mayor or a school superintendent or a state health commissioner and want to know “how do I get more people to quit smoking or eat healthier diets?” you’ll be able to look at these communities and see how it’s done.
Under the new health care law, we’re also helping the private sector promote better health. Private employers have long been leaders in setting up wellness programs that help workers stay healthy and out of the hospital. Now, the ACA will increase the workers’ rewards up to 30 percent of their cost of health coverage for participating in a wellness program and meeting health benchmarks – a strategy with proven success.
That will give businesses a little extra assistance to invest in a healthy workforce.
The new law also directly addresses some of the obstacles that keep Americans from staying healthy. For example, we will train and support new primary care doctors and nurses, to address the shortage experienced by too many Americans.
And because too many people end up in the emergency room with costly conditions that could have been treated cheaply if they had been caught early, it eliminates co-pays for preventive care like mammograms and vaccines.
Whether you’re a city council member, a human resources VP, or a parent, the legislation signed by the President will make it easier for you to do more to keep the people who are important to you healthy, whether it’s your neighbors, your workers, or your children.
Still, no matter how successful we are at promoting healthier lifestyles, Americans are still going to get sick or injured. And when they do, we need to make sure they get the correct care.
We have models for how to do this. Across the country, there are practices and hospitals where patients consistently get the right care at the right time. Yet far too many Americans who turn to our health care system to get better continue to get care that actually makes their health care problems worse.
So we asked, what can we do in the federal government to help effective models of care spread? And a lot of those answers went right into the new health care law.
One of the challenges health care providers face is that they often don’t get rewarded for doing the right thing. Sometimes they even get penalized.
For example, we know that one in five patients in Medicare is back in the hospital within 30 days of being discharged. Sometimes, these readmissions are unavoidable. But often it’s because nobody followed up to make sure they were taking the right medicines or getting the right wound care.
Today, there’s no financial benefit for the hospital that does the extra work to coordinate with the facility providing follow-up care.
So as part of the new law, we’re funding a pilot programs for bundled payments, to reward coordination of care within the hospital and upon release.
Hospitals in Denver and Philadelphia have reduced readmissions in targeted cases by over 30 percent. With this effort, we hope to replicate these results across the country.
Another promising approach is the medical home. In these practices, patients get care from teams of doctors, nurses, social workers, and counselors who coordinate care to cut down on unnecessary treatments and work closely with patients to make sure they’re managing their chronic conditions.
In several states across the country, we’ve seen that this model of care can lower costs from chronic disease, lower costs from emergency room visits and hospital stays, increase access to preventive care and improve patient satisfaction.
But it’s hard for doctors and nurses to practice this way because the current system rewards them for how many appointments and treatments their patients get, not how effectively they work together to keep people healthy.
So we’re launching a new initiative in which Medicare will join with Medicaid and private insurers to support as many as 1,200 medical homes in eight states across the country.
This will allow many more practices to adopt these models, which allow doctors to focus on what they do best: keeping people healthy.
A third example of how we’re helping health innovations spread is electronic health records.
Over the last few decades, we’ve seen industry after industry use information technology to bring down costs and improve customer service.
And I’ve seen firsthand how it can make the same difference in health care. When I visited the neonatal ward at Cincinnati Children’s Hospital, for example, they told me they had gone 1,000 days without a serious safety incident – a record they credited to their use of electronic health records.
And yet, when this Administration came into office, just two in ten doctors and one in ten hospitals used a basic electronic health record.
So through the Recovery Act, we’re working to eliminate the obstacles that are stopping other hospitals and health practices from doing what they’re doing in Cincinnati.
We’re funding Regional Extension Centers where doctors from small practices that don’t have IT departments can get hands-on advice about how to set up the technology.
We’re investing in our health IT workforce, so that hospitals can find trained workers to run their systems.
And we’re providing financial incentives to doctors and hospitals that use electronic health records to improve care. Later today, we’ll announce that the application process for these payments is open along with new survey data showing that more than four out of five hospitals and more than two out of five doctors already plan to take advantage of these payments.
We eliminated some obstacles, provided an incentive, and now America’s health doctors and hospitals are embracing a technology that will allow them to do their jobs better and provide millions of Americans with improved care.
This is the kind of change we can see across our health care system when we put the weight of government behind our best ideas about how to improve health.
And that’s why I believe the future of health care is bright. .
As a nation, there is no goal more important than better health. Health is also the foundation of our prosperity. Healthy adults are more productive workers. Healthy children are better students. Healthy families can make bigger contributions to their communities.
The historic legislation of the last two years has given us a huge opportunity to improve the health of our nation, bringing benefits to every area of our lives. Let’s not waste it.