Connected Health: Building a second healthcare bridge

BOSTON--Donald Berwick, MD, senior fellow, Institute for Healthcare Improvement, equated healthcare to the Choluteca Bridge in Honduras, which survived Hurricane Mitch in 1998 only for the river itself to move and no longer flow beneath it. “That is American healthcare,” Berwick told an audience at Partners HealthCare’s 10th Annual Connected Health Symposium.   

“I don’t want to deny the miracles or the glory of biomedicine,” he said. However, the tide has turned so healthcare now should encompass chronic disease management, patient support and work upstream to focus on prevention. In other words, it needs to reflect the Triple Aim: better population health, experience of care and lower per capita cost, he said.

“I’m not seeing a major effort yet to build a second bridge, but building a second bridge is the right way, the only way,” he said.

The Southcentral Foundation (SCF) in Alaska and its Nuka system of healthcare, however, is an example of the change that needs to happen, he said. Launched in 2004, SCF focuses on home-based, prevention-oriented programs to keep people home, well and out of the hospital. Due to its incredible success in achieving higher quality, lower cost care, the foundation received the 2011 Malcolm Baldridge National Quality Award in 2011.

Within three years, SCF managed to reduce emergency room and urgent care visits by 50 percent, hospital admissions by 53 percent, specialty care visits by 65 percent and primary care visits by 36 percent. In the meantime, Berwick said customer satisfaction hovered around 90 percent with employee turnover at less than 12 percent.

“This is innovation, keeping people at home, well and out of technocracy,” he said. Scaled out, “this would be a lower-cost system by far.”

The healthcare industry continues to engage in wasteful spending with one out of every three dollars not meeting patients’ needs, he said. Underlying causes of wasteful spending include overtreatment, failure to coordinate care, failures in care delivery, excess administrative costs, excessive healthcare prices and fraud/abuse.

“It’s emptying wallets of people who work and it's emptying government coffers,” he said.

Berwick lauded an initiative of the ABIM Foundation, Choosing Wisely, which focuses on encouraging physicians, patients and other healthcare stakeholders to think and talk about unnecessary medical tests and procedures.

“That’s an inkling of a beginning,” he said.