CHICAGO – Don Berwick, M.D., called for more cooperation and prevention in order to usher in what he calls the “third era” of health care, in a keynote on Tuesday at the Society for Healthcare Strategy & Market Development Connections conference.
Berwick, a former acting administrator at the Centers for Medicare & Medicaid Services, and a current senior fellow at the Institute for Healthcare Improvement, described the “first era” of health care as one characterized by a self-monitoring, noble doctor, and the "second era" as one marred by measurement and markets. Together, they create a need to move toward a model based on cooperation and prevention versus competition and treatment, he said.
“Era-one and era-two are in collision," Berwick said, adding: "It can’t work.”
He pointed to the example of Gorje Sanchez, one of 10 siblings in a single-parent household in Holyoke, Mass., whom Berwick met during his run for governor of the state. Gorje had gone to prison for grand larceny, but when he got out, he joined the Holyoke Safe and Successful Youth Initiative, where he received support and treatment to get back on the right path. A year after he joined SSYI, the program’s budget was cut in half.
“If Georje got hit by a bullet, he would be lucky,” Berwick said. The ambulance would come, paramedics would be at his side and take him to an emergency department where a team would operate and mobilize all resources to help him.
“We have no problem recruiting resources to treat the bullet, but stopping the bullet, with a Kevlar vest of high school education, vocational support and social service counseling and that safety net, it’s not there,” he added.
Berwick noted that during his time at CMS, overwhelmed with proposals, plans and paperwork, Berwick requested a cover sheet for such things that answered the most essential questions: Will this help people, improve care and health? Will it help the poor? Will this reduce costs?
Berwick ended with a plea for the field to unite and prioritize shared values.
“We have to make an empty bed more valuable than a full one,” he said. “We need a new way to think all together. And I call it Era Three. It has to have a values framework; only values are going to get us out of this, there is no technical route that doesn’t go through reconsidering our values.”