Institute for Healthcare Improvement


Flipping Health Care: From ‘What’s The Matter’ To ‘What Matters To You?’

Patient-centered care is all the rage, but what does that actually mean in the medical trenches?

It means “flipping” the entire notion of health care around, says Maureen Bisognano, President and CEO of the Institute for Healthcare Improvement (IHI), speaking today at the nonprofit group’s annual national forum in Orlando, Fl.

Instead of traditional medical care, which focuses on a patient’s disease or illness by asking the question “What’s the matter?” Bisognano says providers should focus on the person and his or hers individual needs and lead with the much more intimate: “What Matters To You?”

An example: A standard mode of assessing whether a patient’s diabetes is under control is through traditional numeric measures, like blood pressure, cholesterol levels and blood sugar. But isn’t it more meaningful, Bisognano suggests, to measure in more human terms, like how many leg amputations and heart attacks were avoided by controlling diabetes, or how many fewer trips to the ER were needed? And of course, what was the dollar savings?

It’s worth listening to Bisognano’s far-reaching talk here, which touches on what health means to a 96-year-old (living pain-free and being productive) and highlights “centering pregnancy” — group prenatal and maternity care visits in which women and teams of providers support each other.

Bisognano also features a young Millennial named Trevor, a self-described “diabetes evangelist” who explains why he’s glad he has Type 1 diabetes (it’s so much easier to be healthy when you’re forced to focus on the nutritional content of food); and what true health means to him (answer: it’s all about staying high-energy in the erratic world of college student life).

The Big Lesson From Brill’s ‘Bitter Pill’ Story, ‘So Big It’s Hard To See’

Time's "Bitter Pill' cover

Time’s “Bitter Pill’ cover

I stopped in to get my car fixed yesterday and found the recent Time issue featuring Steve Brill’s mega-story — Bitter Pill: Why Medical Bills Are Killing Us — still lingering on the waiting-room table, well-thumbed and dog-eared. For a story about a problem that just about everyone already knew existed, the piece has clearly been having a major impact and sparked widespread discussion.

Today, the Cambridge-based Institute for Healthcare Improvement posts a lively and provocative piece that concludes that the current payment system is broken and must be blown up to create one that “incents value improvement.” Written by Jeff Selberg, the institute’s chief operating officer, and Clifford M. Marks, a health care researcher st Harvard Business School, it begins:

Steve Brill’s recent piece on the irrationality of health care costs has inspired so many disparate reactions, it feels almost like a health policy Rorschach: Some see a clear case for a single-payer system. Others point to all-payer rate setting. And many health care executives, as reflected in a response from the Healthcare Financial Management Association (HFMA), saw an “unfortunate and misleading” narrative about rampant greed in health care.

The British writer G. K. Chesterton once observed that “[m]an can always be blind to a thing so long as it is big enough.” We wonder if that isn’t happening here, because there is a far more fundamental truth to be had in Brill’s descriptions of nonsensical charges, of patients forced to the brink of bankruptcy by prices that, frankly, seem extortionary. It’s a lesson so big we seem to have trouble even seeing it.

Payment in health care is not tied to what should be its goal of delivering better value, or better outcomes at lower costs. What’s more, everybody knows it. And it is this sobering reality that Brill’s article lays bare: Nobody has any faith in the current reimbursement system – and they shouldn’t. As Brill hammers home in vignette after vignette, health care charges are almost entirely unhinged from patient welfare. You can move to single payer. You can ratchet up taxes on hospital profits. You can enact tort reform. But none of it will work if we fail to blow up the current payment system, and replace it with one that incents value improvement.

When Jeff was CEO of Exempla Healthcare, he told his board – let’s have no rate increase for our chargemaster (the hospital listing of charges so appropriately maligned in Brill’s piece). We all know the chargemaster is crazy, it’s distorted, it’s meaningless. And his CFO responded, great, but if you want to freeze the rates, we’re going to take a $10 million hit. Continue reading

DIY Dialysis, And Other Stories About Improving Patients’ Lives

This morning, Maureen Bisognano, president and CEO of the Institute for Healthcare Improvement here in Cambridge, spoke movingly about the power of storytelling to help radically change the way health care is delivered to patients.

In her keynote speech, delivered at IHI’s annual forum on quality health care held in Orlando, Bisognano recounted the story of a Swedish man with kidney disease:

Christian Farman, patient advocate and nurse

This past May, I made my annual trip to visit with our partners in Jönköping, Sweden and met a young man named Christian Farman. Christian was a mechanic at Saab Avionics and an athlete when he came down with glomerulonephritis and was placed on dialysis. The side effects of his treatment – nausea, fatigue, thirst – were taking over his life.

Frustrated he approached his nurse, Britt-Mari Banck, and made what to him was a simple and sensible request–to be allowed to administer his own dialysis. You see, Christian had researched self-dialysis and was convinced that by taking control of his treatment, he could reduce potential infections, experience more consistent care, and mitigate the side effects of treatment. He told Britt Mari, “You have to help me treat myself; I need control of my life.”

It’s easy to imagine what the usual response might be. “You can’t do that.” “That’s not how we do things here.” But Britt Mari saw something in Christian’s face…courage. Continue reading