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At the Rural Policy Institute I heard many people’s views on the Affordable Care Act (or PPACA as it is known by folks that don’t use “ObamaCare” in polite company). As a prelude to our Hill visits we heard from representatives of HRSA, the VA, the National Health Information Technology office, and the USDA. We heard about the problems with PPACA from Senators Pat Roberts (R-Kansas), Senator Mike Johanns (R-Nebraska), Senator Mike Enzi (R-Wyoming). We also heard about the huge opportunities of the Affordable Care Act from Senator Daniel Inouye (D-Hawaii) and  Senator Bernie Sanders (I-Vermont). I had to leave before Senator Ben Nelson (D-Nebraska) spoke so I don’t know if he spoke of the Affordable Care Act or PPACA.

The highlight for me was getting to hear Don Berwick. Dr Berwick spoke of his new vision for CMS

CMS can and should be a major force and a trustworthy partner for the continual improvement of health and health care in this country. We all agree that we want the highest quality health care system possible, a system that coordinates and integrates care, eliminates waste, and encourages prevention of illness. With over 100 million beneficiaries depending on us each day, CMS has an important role to play in improving our nation’s health care delivery system. We are striving to meet this challenge, while attending diligently to the crucial, day-to-day work of our operations and preserving and enhancing the integrity of our payments, our programs, and the Trust Funds.

He again stated his vision to bring the Triple Aim to CMS. He said this would be accomplished through boundarilessness, speed and agility, unconditional teamwork, value innovation, and customer focus. He then went into specific work that CMS was focusing its energy on. This work can be categorized as involving excellence in operations, improved care for patients, integrated care for populations, and improved health for populations and communities.

Like Senator Sanders I think the Affordable Care Act offers incredible opportunities for care transformation, even more so after hearing Dr Berwick.

Addendum: Dr Berwick’s talk can be found here at 1:13:00

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I have been a follower of Paul Grundy for a while. I first wrote of him in 2008 (the year that I first met him). In 2009, I posted a link to his slides regarding the US healthcare “system” and also wrote of an effort he made to transform Alabama healthcare delivery. I went to the Alabama Rural Health Conference in Tuscaloosa this week and heard him again today. He is a compelling speaker and plugged into the federal level  transformation.  He believes in the system he is trying to get American’s to purchase. He claims that the Accountable Care Act  ACO section was written to allow the Patient Centered Medical Home to be operationalized. It only requires the capacity to care for 5000 Medicare lives which means that a reasonable small primary care office could qualify. In his talk he points out that Denmark has transitioned from 122 hospitals to 20 hospitals and the bulk of the care is done in the PCMH using enhanced home monitoring and proactive rather than reactive care. His other major point is that the PCPCC is a collaborative arrangement that includes large employers and government payors so there will be no repeal and replace…they like the bill and the rules are going to be written and so ingrained that care delivery will be changed forever no matter how many conservative Republicans think otherwise. He point to the VA and DOD efforts as proof positive. Private groups are consistently demonstrating a reduction in cost of 10% or more. Threatening if you make your money off of third-party administered claims (as does BC/BS of Alabama)… 
 

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