“Return the Money” for Health System Transformation

By Jill Zorn 

The Institute for Healthcare Improvement (IHI) and its Leadership Alliance, is working to develop “new rules” for health system transformation.

IHI, founded by Don Berwick, a former administrator of the Centers for Medicare and Medicaid Services, invented the “Triple Aim,” the holy grail of health system redesign that requires simultaneous pursuit of better care, lower costs, and improved health.

The Leadership Alliance is composed of 40 large health and hospital systems across the country, including Hartford HealthCare, that believe, “we must change the dialogue about health care from one that focuses on reimbursement and regulation — to one that makes the pursuit of health and healing paramount.”

In a recent article in the Journal of the American Medical Association, Berwick writes that while the Affordable Care Act (ACA) has been crucial to jumpstarting efforts to achieve the Triple Aim, it is critical  that health care organizations promote system transformation, “from the inside out.”

“…reliance on the ACA alone is wholly insufficient to accelerate delivery system reform to the level needed. Laws, regulations, and payment changes cannot, alone, create health systems that realize the full promise of the Triple Aim. Leaders involved in health care must be actively and directly involved in catalyzing change needed to achieve the Triple Aim….”

Together, the members of the Leadership Alliance have developed a set of new rules for “radical” redesign of health care.  Here is the list:

  • Change the balance of power
  • Standardize what makes sense
  • Customize to the individual
  • Collaborate/cooperate
  • Eliminate walls
  • Assume abundance
  • Return the money
  • Make it easy
  • Move knowledge, not people
  • Create well being
  • Create joy in work

While this list may appear a bit cryptic at first, it contains some pretty revolutionary ideas.  Last week, The Commonwealth Fund wrote a blog about the new rules, highlighting and further explaining several of them.   They also hosted a tweet chat about them, which featured Don Berwick and two other experts. This link has a summary of the chat.

One of the rules that jumps off the page is “return the money.”  As the Commonwealth Fund blog explains:

“Following the rule return the money would mean savings would be shared with patients, employers, and communities to ensure care is affordable and to promote health or invest in other sectors such as education or housing that influence the determinants of health. Not only would such efforts help those who struggle to pay medical bills, they could benefit all of those who live in poor and underserved neighborhoods.” 

As our recent Reform to Transform event, Getting to Better Health, Connecting Care and Community, emphasized we are spending too much money on clinical care and not nearly enough on the social and economic determinants of health.  Achieving savings in health care is difficult enough, but making sure those savings are captured and reinvested is an even greater challenge that we will need to meet if we are truly going to improve health.

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