Q&A with Former Medicare and Medicaid Chief Donald Berwick: Be Willing to Embrace Change: Devoting Energy to Improving Public Health in the U.S

By Johnson, Teddi Dineley | The Nation's Health, May-June 2012 | Go to article overview

Q&A with Former Medicare and Medicaid Chief Donald Berwick: Be Willing to Embrace Change: Devoting Energy to Improving Public Health in the U.S


Johnson, Teddi Dineley, The Nation's Health


Four months after the Affordable Care Act was signed into law, Donald Berwick took the reins of the Centers for Medicare and Medicaid Services. During 17 months at the agency's helm, he oversaw numerous improvements to Medicare, including the expansion of preventive screening services and changes to prescription drug benefits. Now a senior fellow at the Center for American Progress, Berwick, MD, MPP, will be the keynote speaker at the opening session of APHA's Midyear Meeting in Charlotte, N.C., on June 26.

As budgets and workforces shrink, everyone in the health system is being asked to take on more duties. Is it possible for public health professionals to adapt to this new workload while also increasing their quality, efficiency and effectiveness, and if so, how?

Public health, like all production systems, has processes (through) which it gets its work done. Those processes can be continually improved using modern methods of quality management and process improvement. I think that public health professionals are very badly needed in the health care system of the future. We need the energy to really devote to the improvement of health status in the population but it may require of public health professionals, as it will require all other professionals, to rethink how they do their work so they can experience more efficiency and more satisfaction in their achievements. Improvement of work involves a level of openness and receptivity to very new ideas, ideas that could at first be uncomfortable. The challenge (for) public health professionals, as it is for all others, is to be willing to embrace change in the traditional approaches to the way they get their work done.

What are the biggest challenges in public health today and how can they be transformed into opportunities?

At CMS, I brought in the concept of our mission being encoded as the triple aim, with a three-part aim. The three aims are better care for individuals when they're ill or in health care, better health in populations and lower cost to improvement of care. Of those three, the most difficult in some ways is the improvement of the health of the population, because as public health professionals know, the vast majority of the variation in health status in our country is due not to variation in health care but rather it's a variation in the risks and the upstream causes of ill health. That's where the real payoff lies if we want a continually healthier public. In these areas, we need better science and a much more strategic investment in helping people make better choices and find ways to help themselves. …

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