donald berwick


Berwick Platform: ‘Seriously’ Explore Single Payer, Review Cost Control

Dr. Donald Berwick (Jesse Costa/WBUR)

Dr. Donald Berwick (Jesse Costa/WBUR)

Granted, a candidate releasing his platform on health care for a race that’s a full year away might not strike you as big breaking news. But what if that candidate is one of the country’s leading health policy thinkers? And what if he’s stepping right into territory that proved highly contentious on the federal level?

That candidate is Dr. Donald Berwick, former chief of Medicare in the Obama administration, and that territory is the idea of a “single-payer” system — a sort of “Medicare for all” that’s common in other developed countries but that faces some strong opposition in the United States. (On the national political scene, Berwick took some major flak from opponents for expressing enthusiasm for Great Britain’s National Health Service.)

Berwick released his official health care platform for Massachusetts this morning, and it includes these two points — Chapter 224 refers to the state’s latest health reform, aimed at controlling costs:

As Governor:

On day one, I will convene a summit of all stakeholders to conduct a top to bottom review of Chapter 224 and develop an action plan to ensure it meets Triple Aim goals of better care, better health, and lower cost. If Chapter 224 results lag behind, within my first 100 days I will work with the Legislature to craft a new wave of stronger legislation to incentivize increased transparency, payment changes, and care reorganization.

It is time to explore seriously the possibility of a single payer system in Massachusetts. The complexity of our health care payment system adds costs, uncertainties, and hassles for everyone – patients, families, clinicians, and employers. I will work with the Legislature assemble a multi-stakeholder Single Payer Advisory Panel to investigate and report back within one year on whether and how Massachusetts should consider a single payer option.

Readers, reactions? Let’s note that neighboring Vermont is already pursuing a statewide single-payer system, so the idea is not all that revolutionary around here. But Massachusetts is a very different state, where health care dominates the economy to a far greater extent than in Vermont. Will the idea fly here? Does it make you more or less likely to vote for him in that distant election? Does it mean that at the very least, the pros and cons of a single-payer system will figure in campaign debates?

Berwick’s full health care platform is here. A couple of other points worth highlighting: Continue reading

How ‘The Berwick Report’ May Play Out In Massachusetts

Dr. Don Berwick, a candidate for governor of Mass.

Dr. Don Berwick, a candidate for governor of Mass.

Don Berwick, a Democrat, is running for Governor of Massachusetts. But yesterday, he issued a “Letter to the people of England.” The subject? Britain’s National Health Service (NHS) and Berwick’s recommendations for improving safety and restoring confidence after higher than expected death rates at one hospital rocked the country.

Berwick conducted his review and issued his report, pro bono, at the request of Prime Minister David Cameron. Today, he spoke with reporters in Boston about the health care and political lessons his work in the UK offers for Massachusetts.

Q: How do you think this report relates to people in Massachusetts. What do they take away from it?

A: Well…this report is not part of the campaign; I had agreed to do it prior to the announcement and getting people involved with the campaign, and the work does come to a close now, except for perhaps occasional advisory interactions. But this is about large system change, I mean, here you have a system with 1.4 million employees. That’s the size of the National Health Service, spending 100 billion pounds. And it’s a good example of how a very large system constantly needs the attention of leaders to the continual improvement of whatever it’s trying to accomplish. It’s an example of how the field I’ve been investigating for 30 years now, continuous improvement in quality, can be brought to scale. Continue reading

Berwick Weighs In On Dispute Over Medical Quality Standards

Medicare’s Pioneer ACOs are arguably leading the most important experiment under the Affordable Care Act.

Back in 2011, just before Medicare named the 32 providers who would test new ways to deliver care with better quality and lower costs, Don Berwick, then the leader of the Centers for Medicare and Medicaid Services (CMS) said, “for Medicare, coordinated care represents the most promising path toward financial sustainability and away from alternatives that shift costs onto patients, providers, and private purchasers,” in this New England Journal of Medicine article.

Don Berwick, former head of Medicare and Medicaid, steps in to mediate a dispute over hospital quality measures.

Don Berwick, former head of Medicare and Medicaid, offers advice on hospital quality measures.

So when Berwick (who is also seriously considering a run for governor of Massachusetts) said last week that he’s advising some Pioneer ACOs in their dispute with CMS about how to measure quality, my ears perked up. Today, he clarified that he’s only spoken to one ACO executive who called to ask for his advice. Berwick points out he can’t, in accordance with federal ethics rules, get involved in direct negotiations.

Berwick says it’s important to “stay on the high road with respect to the purposes here. The idea of ACOs is important and it (quality) is an important component in the whole move toward integrated care. So let’s not throw the baby out here.”

Berwick, who is also busy helping Britian’s National Health Service recover from an “enormous illness”, offers the Pioneer ACOs some guidance.

“As you work through solutions, stay on the high road. And then, try to get to a platform where the discussion is not, will we play or not, but can we work this through at a technical level.” Continue reading

Berwick Mulls Run For Mass. Governor, State House News Reports

Dr. Donald Berwick

Think incumbent Gov. Deval Patrick is intensely oriented toward health care? Could be you ain’t seen nothing yet. State House News Service reports that Dr. Don Berwick, a national leader on improving the health care system, and the Obama administration’s former chief of Medicare, is considering a run for governor to succeed Patrick. From State House News:

Dr. Donald Berwick, a Boston-based pediatrician and former Obama administration health care official, is giving serious consideration to running for governor as a Democrat in 2014, injecting himself into a conversation limited so far to two statewide officeholders.

Berwick, who served for a year and a half as administrator of the Centers for Medicare and Medicaid Services before resigning in the face of Republican opposition to his permanent confirmation, has been talking with family, friends, civic and business leaders about a possible run.

He met privately on Monday with Lt. Gov. Timothy Murray in his State House office to inform the Democrat of his plans, and has also spoken with state Democratic Party officials.

“That’s correct. I’m strongly considering it,” Berwick confirmed to the News Service on Tuesday.

Berwick joins Murray and Treasurer Steven Grossman among those giving serious thought to a run for governor in 2014 when Gov. Deval Patrick plans to leave office at the end of the second term.

Readers, should he run? Why or why not?

Berwick On Mass. Health Reform: More Pain, More Gain

Dr. Donald Berwick, former Medicare chief

I don’t know about you, but when my dentist says that I’m about to experience some “temporary discomfort,” I know what that really means is, “Hang in there, this is going to hurt like heck.”

In the Boston Globe, Dr. Donald Berwick, the widely admired former chief of Medicare and one of the nation’s leading health policy mavens, has just weighed in on the competing proposals for cost-cutting reform in Massachusetts. He argues in favor of aiming for more ambitious cost-cutting targets: The House’s tougher goal rather than the Senate’s less ambitious one, or even the still-tougher target put forth by business and religious groups.

I must say that what struck me most in his essay were the repeated references to pain for a good cause. Massachusetts needs “large-scale changes in delivery that will be temporarily uncomfortable for most providers.” Government must step in because “The changes are just too hard for most to face.” And “Undoubtedly, this transition will be wrenching.” I’m left wondering: Is there a political equivalent to Novocaine?

The whole piece is an important read but here’s an excerpt: Continue reading

Berwick Says He Thinks Health Law Will Stand

Wishful thinking? Maybe.

But Donald Berwick, former administrator of the Centers for Medicare and Medicaid Services tells Kaiser Health News that despite “messaging problems,” he believes the national health law will stand. “I expect the law will be upheld,” he says.

(Next week, the U.S. Supreme Court hears arguments on the law’s constitutionality; a decision is expected in June.)


Dr. Berwick Exits Washington, Optimistic About Health Reform Law

Dr. Donald Berwick served as Medicare chief for 17 months

Despite his messy, politically-tinged ouster as the administrator of the Centers for Medicare and Medicaid Services, Dr. Donald Berwick remains persistently optimistic about the future of health reform.

This morning, Berwick spoke to WBUR’s Tom Ashbrook and continually brought the conversation back to the huge potential of the nation’s health reform law, which he called “majestic.”

Berwick said the reason he lost his job in Washington boils down to this: “An absence of authentic dialogue on what’s needed in health care.”

Still, he said: “It’s a thrilling time in health care…major improvements are possible if we can buckle down in this country and get health care to perform how we want it to…We have to cross the bridge from fear to optimism.” Continue reading

A Snapshot Of Dr. Berwick’s Successor

Kaiser Health News offers this mini-profile of Mary Tavenner, a former nurse, hospital executive and HHS deputy slated to replace Don Berwick as administrator for the Centers for Medicare and Medicaid Services. Berwick, who resigned due to GOP opposition, will step down later this week. (Here’s a copy of the memo from Health and Human Services Secretary Kathleen Sebelius announcing Tavenner’s appointment.)

Before coming to CMS, Tavenner served as secretary of Virginia’s Health and Human Services where she oversaw 12 agencies that employed 18,000 people. Her career also included 25 years working for the Hospital Corporation of America where she started as a staff nurse and became president of outpatient services, according to an alumni profile posted on the Virginia Commonwealth University’s web site. She has also previously served as acting CMS administrator.

Continue reading

Despite Respect, Berwick Falls Victim To Politics

(CMS)Dr. Donald Berwick

The Associated Press reports:

“WASHINGTON — The point man for carrying out President Obama’s health care law will be stepping down after Republicans succeeded in blocking his confirmation by the Senate, the White House announced Wednesday.

Medicare chief Don Berwick, a Harvard professor widely respected for his ideas on how to improve the health care system, became the most prominent casualty of the political wars over a health care overhaul whose constitutionality will be now decided by the Supreme Court.”

The AP report includes an eloquent excerpt from an email Dr. Berwick sent to his staff, describing his “bittersweet emotions”:

“Our work has been challenging, and the journey is not complete, but we are now well on our way to achieving a whole new level of security and quality for health care in America, helping not just the millions of Americans affected directly by our programs, but truly health care as a whole in our nation,” Berwick wrote.

Dr. Berwick’s exit was long expected, as we reported here, here and here. Will he return to the Cambridge institution whence he came, the Institute for Healthcare Improvement? Please stay tuned.

New Rule Makes It Easier For Docs and Hospitals To Join ACOs

Berwick: New rule should 'create a more feasible on-ramp' for providers

Kaiser Health News reports on the long-awaited “final rule” governing Medicare accountable care organizations, or ACOs, the much-touted managed health care systems that under national health reform are supposed to better coordinate care while saving money.

The regulations, released today, cut the number of performance measurements required from hospitals and physician groups, eliminates electronic health record requirements, removes financial risk for some providers and makes up-front money available for rural and small physician-owned groups.

Introducing the new regulations in a commentary in today’s New England Journal of Medicine, Donald Berwick, the administrator for the Centers for Medicare and Medicaid Services wrote that the easing of these and other restrictions should “create a more feasible and attractive on-ramp for a diverse set of providers and organizations to participate as ACOs.”

KHN reports:

The administration made several concessions to the health industry in the final rule announced Thursday. Continue reading