IHI 2016: Don Berwick on healthcare under Trump and the future of quality improvement initiatives

A compass pointing to the word "quality."
During a press briefing on Monday at the Institute of Healthcare Improvement’s 28th annual National Forum on Quality Improvement in Healthcare in Orlando, Florida, Don Berwick, the former administrator of the Centers for Medicare & Medicaid Services, gave some preliminary thoughts on the new White House administration and its impact on healthcare delivery.

ORLANDO, Fla.—Like many Americans, Don Berwick, M.D., says his head is still spinning from the results of last month’s presidential election and what the fallout will mean for the healthcare industry.

Don Berwick

During a press briefing on Monday at the Institute for Healthcare Improvement’s (IHI) 28th annual National Forum on Quality Improvement in Healthcare in Orlando, Florida, the former administrator of the Centers for Medicare & Medicaid Services gave some preliminary thoughts on the new White House administration and its impact on healthcare delivery.

Berwick, who will deliver the closing keynote address at the conference on Wednesday, is president emeritus and senior fellow of the IHI, an independent, not-for-profit organization that aims to drive healthcare improvement.

The future of affordable care

Based on President-elect Donald Trump’s health policy plans touted during the presidential campaign, Berwick says the federal government may take on less of a role and instead will shift the responsibility and authority to states.

“States could end up having more on their plate,” he says, noting that it will result on a bigger cost burden for patients. “Healthcare organizations will be left holding the bag … The burden will fall heavier on people with lower income and risk.”

As for Trump’s plans to repeal and replace portions of the Affordable Care Act, healthcare institutions are “deeply imperiled” by the threat of the government eliminating subsidies, rolling back Medicaid expansion and taking away taxes that support the expansion of health coverage. It potentially could leave 22 million people without health insurance, he says.

“It would be a disaster for many lives. These are largely vulnerable people. They will get hurt. Coverage and outcomes are related. Without insurance, people have worse outcomes,” Berwick says.

Price and program transparency

Trump’s pre-election healthcare platform called for complete price transparency, and elements of the Affordable Care Act also call for transparency to help make the healthcare system easier to understand, creating a more competitive market. That meant CMS had more authority and responsibility to make data more available to the public. That was a difficult journey, Berwick says, because historically CMS kept the data guarded and tightly controlled for research. Over time data has become more available but he’s unsure what the future holds with the new administration.

Tom Price [Trump’s pick for the new head of the Department of Health and Human Services] is a fan of doctors and doctor practices. And doctors are uncomfortable with transparency so I’m not sure which way he will call this,” Berwick says.

CMS star ratings and quality improvement

Although Berwick isn’t sure what will happen to the star ratings system under the new administration, he says he is certain quality improvement in healthcare and the goal of the Triple Aim to improve individual care, boost the health of patient populations and reduce overall costs, will continue. Although there is controversy over the methods CMS used for the star ratings, it was a step toward quality, Berwick says. But the methodology needs to become more sophisticated so the ratings become truly meaningful. The good news, he says, is that the star ratings caused hospitals to pay attention to the problem. Now, he says, it’s time to make the measures better.