New CMS leader maps his plan for transforming healthcare

WASHINGTON-The most powerful person in the nation's healthcare system came out of seclusion in mid-September to make a heartfelt call for insurance-industry assistance in reforming American healthcare.

Donald Berwick, administrator of the Centers for Medicare and Medicaid Services (CMS) made an obvious effort to avoid bashing insurance companies, when speaking at a recent America's Health Insurance Plans (AHIP) meeting. Although, some bashing had come just prior to the event from Health and Human Services (HHS) Secretary Kathleen Sebelius. She had issued a stinging letter criticizing insurers for "falsely blaming" reform legislation for new premium increases.

INSURERS SEEN AS BAD GUYS

At the same time, Berwick emphasized the need for payers and providers to change the way they do business. He cautioned that authenticity matters and that companies that wish only to preserve the status quo will not be seen as constructive contributors to change.

"We just do not have time for games anymore," he said, warning that CMS will hold industry accountable "when we need to."

In his AHIP speech, Berwick said he would transform the system by promoting prevention, improving quality and patient safety, and eliminating fragmented care. An integrated care system, he explained, is one in which the doctor doesn't prescribe a patient a medication that would cause an interaction with some other medication the patient might be taking, for example.

WORKING QUICKLY

Berwick is under pressure to make such changes fairly quickly, as he has only a temporary recess appointment to his CMS job, which runs out in early 2012. Republican opposition to Berwick's appointment delayed Senate confirmation last spring, prompting the Obama administration to make the recess appointment on July 7, while the legislators were out of session on summer break.

The White House recently resubmitted Berwick's nomination to the Senate in hopes for faster action on a permanent appointment, but that's not likely to happen until after this month's elections-if at all.

Berwick now is spending more time on Capitol Hill, testifying on how the administration is implementing the Patient Protection and Affordable Care Act (PPACA) and how it will impact seniors and the poor who rely heavily on government-funded health programs.

The CMS chief won general applause from insurers at the meeting, even though they are unhappy about severe rate cuts in Medicare Advantage payments and major changes required in their business practices.

In response to critics who accuse him of seeking to ration care, Berwick said he would reduce costs by "eliminating waste and needless hassles," but not, he emphasized, by withholding any care that is beneficial to patients.

In acknowledging the need to reduce costs "without harming a hair on any patient's head," Berwick left open the question of how much to lower spending and where. In his first public comments since being nominated to head CMS last April, Berwick said that these issues will be decided by each local community, and not by "a massive, top-down national project."

Improving the system will require the participation and support of all members of the healthcare community, he said. He identified insurers and pharmacy benefit managers as keys to success in implementing what he called "the most significant healthcare legislation since enactment of Medicare and Medicaid."

Berwick highlighted provisions that will provide access for 32 million Americans without coverage, help small businesses offer insurance and close the Medicare drug benefit donut hole.

An experienced pediatrician, Berwick is also adjunct staff in the Department of Medicine at Children's Hospital Boston, and a consultant in pediatrics at Massachusetts General Hospital. He is a clinical professor of pediatrics and healthcare policy in the Department of Pediatrics at the Harvard Medical School and a professor of health policy and management at the Harvard School of Public Health.

Most recently, he led the Cambridge, Mass.-based Institute for Healthcare Improvement.