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Out of the Blocks: Where Does Health Care Go From Here?

By Maureen Bisognano | Tuesday, December 11, 2012

Here at IHI, one of our most vital roles is to be a convener of some of the most innovative and passionate people in health care from around the world. And there is no more exciting example of our ability to bring great people together than our annual National Forum which we just completed in Orlando.


This year, more than 5,500 men and women from around the world joined us to teach and learn; to connect and share; to push innovation forward to improve care for millions of people. It was hugely enlightening and uplifting ---- one of our best forums ever.


While the Forum is by far IHI’s biggest and best-known gathering, we bring people together hundreds of times each year to tackle a wide variety of health care challenges. For me, one of the most exciting gatherings came just two days after the recent presidential election, when we brought together more than 100 health care leaders in Washington, DC, for a session we called Out of the Blocks.


What an amazing day! There was clearly a sense of excitement over the affirmation of the Affordable Care Act. As former Senate Majority leader Bill Frist, MD, put it so aptly: “Nothing has changed’’ in terms of who controls the House, Senate, and White House, “but in health care, everything has changed.”


Our mission for the day was to define where we now stand in health care in America, where we need to go, and how we get there.


People attended from Capitol Hill and the Obama Administration, as well as from hospitals, physician groups, think tanks, insurance companies, and safety net organizations.


I was fascinated by the powerful sense of ambiguity that seemed to develop almost organically throughout the day. Initially, there was a sense of relief that the election was over and the Affordable Care Act was thus solidly affirmed.


But the group had barely paused to enjoy the sense of relief and stability, when the sentiment in the room began to shift to a second reaction: Uncertainty!


Where do we go from here? What precisely are we aiming for? In the staggering complexity of the system that is American health care, how do we find a pathway through the thicket?


Perhaps the most foundational consensus of the day, however, was the urgent need to drive down costs ---- and to do so quickly and thoughtfully. No one defended the status quo. No one said, “I need to expand my budget or else.” (This theme continued to echo throughout the Forum in Orlando, as well.)


I left the session in Washington with a sense of crystal clarity that our job at IHI is not only to convene these great thinkers and innovators, but to work cooperatively with them to identify the way forward; to find the way to the new American health care system we all want.


And to me that speaks directly to the Triple Aim, which was outlined nearly six years ago here at IHI by John Whittington, Tom Nolan, and Don Berwick. In fact, when I think about the discussion during the day, I think it

is fair to say that the consensus solution would align quite well with the Triple Aim:

  • To improve the health of the population;
  • To enhance the patient experience of care (including quality, access, and reliability); and
  • To reduce costs.


LEARN MORE: Leading Population Health Transformation, Feb. 22-24, 2017, in San Diego, California

Discussions around cost were dynamic, not only because no one defended the status quo but because some people are setting very aggressive cost goals. Susan DeVore, CEO of the Premier Health Care Alliance, which comprises 2,600 hospitals, said that many of her members are determined to run their operations at Medicare rates ---- while some are even aiming for Medicaid rates. This kind of thinking is courageous and bold, and very new indeed. Could you imagine this happening even just three years ago?


It is clearer to me than ever that our role at IHI is to work with you to find the most intelligent, effective, patient-centered pathways forward. We’re making progress ---- all we have to do now is accelerate it by an order of magnitude!


Thanks to everyone who made it a wonderful National Forum.


-Maureen Bisognano

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