Donald Berwick, M.D., did not mince words during his keynote address at the Healthcare Financial Management Association annual meeting taking place this week: “The public is quite confused and scared” about the direction of the health care industry, said the former Centers for Medicare and Medicaid Services administrator.

Now running for governor in Massachusetts, Berwick described the environment in Washington, D.C. as both toxic and counterproductive. He served as the leader of CMS during the early days of the Obama administration and is widely credited as being a leading architect of many of the reform elements eventually passed under the Affordable Care Act.

Berwick said the health reform effort is a step in the right direction--despite the political volatility surrounding it. “The hospital comes under new incentive models,” he noted, such as accountable care, patient-centered medical home, and value-based payment models. Such a shift is crucial, he contended, because poorly coordinated, fragmented care under fee-for-service has resulted in runaway costs that drain vital resources from other public spending programs and the economy overall. “What health care takes is what labor, schools and bridges don’t get.”

Although Berwick cited the lack of civil discourse over health care and other issues as figuring in his decision to leave Washington, he remains optimistic that the industry will be able to address the problems wrought by fragmented care. He cited several examples of health systems embracing technological tools and new staff roles to improve care and lower costs. Nuka, a clinic in Anchorage, Alaska, has reduced ER usage and hospital admissions by adopting a medical home model. And Ryhov Hospital in Sweden now allows patients to administer their own kidney dialysis and free up nursing time. That’s an example, Berwick said, of the kind of mindset shift American providers will need to undergo.

“Don’t wait for Washington,” he urged the several thousand attendees at the Orlando conference. “Get in touch with the basics and put patients first.”

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