The year hasn’t been a great one for the Affordable Care Act (ACA). Though it managed to survive numerous legislative repeal-and-replace efforts, its future is still uncertain.
That’s been frustrating for Don Berwick, MD, MPP, the former Centers for Medicare & Medicaid Services administrator. Dr. Berwick coined the term Triple Aim and, in his current role as president emeritus and senior fellow at the Institute for Healthcare Improvement, he is doing all he can to continue to champion the aim’s tri-fold mission to:
“In the ACA, there were quite a few initiatives to help care change and evolve— to become more team oriented, more based in the community, to help people transition from institutions to home, to work on patient safety, to give more transparency, to give voice to patients. All of these initiatives came under threat, of course, with the repeal-and-replace effort,” Dr. Berwick recently told The American Journal of Managed Care.
“And they’re still under threat administratively. I am worried about back-pedaling on commitments to better care.”
The uncertainty in the health care environment endangers efforts to improve quality, Dr. Berwick said.
“We haven’t seen an articulation from this administration of a quality agenda that is scientifically grounded,” he told the publication. “And so, those who have been invested in safer, better care haven’t received a signal about what’s going to be supported.”
Cancelled cost-sharing reduction subsidies and threats to Medicaid funding don’t create an atmosphere that energizes a focus on quality improvement, he said, since mere stability is on the line. Even the Center for Medicare and Medicaid Innovations (CMMI) may undergo big changes.
“The rhetoric in the [Request for Proposal] right now is talking about more local control, that answers don’t come from Washington,” Dr. Berwick said in the interview. “It’s a little confusing to me because the whole idea of CMMI was the release of a tremendous amount of local innovative energy. I hope we don’t lose that.”
Despite funding threats and haziness surrounding the future of the ACA and its Triple-Aim-supporting initiatives, Dr. Berwick is sure of one thing: health care systems will continue to innovate despite the challenges.
They can’t help it.
“They always have, and they always will,” Dr. Berwick said. “The system wants to innovate.”
In his work at the Institute for Healthcare Improvement, he told The American Journal of Managed Care that he comes across “gems” regularly. These innovators have decreased patient waiting times, improved care of people with chronic conditions, improved surgical interventions, and reduced costs. He mentioned small, rural hospitals that “are just knocking their socks off with what they’re able to do.” Technology breakthroughs, which will deliver more control to patients, will improve health and drive down costs, he predicted.
The Institute for Healthcare Improvement’s Leadership Alliance and its Open School, two separate initiatives that allow health care professionals to learn together how to improve care and lower costs, are active and inspiring, he said. The Open School currently has more than half a million young health professionals learning together in online courses.
“I love it,” he said. “I am sure the younger professionals are ready for the Triple Aim. Those of us who were trained in a different era — we elders — it’s our job is to make it possible.”