To grow and thrive, the healthcare industry must enter a "third era" combining the strongest features of previous healthcare landscapes, according to former Centers for Medicare & Medicaid Services Administrator Donald Berwick, M.D.
Healthcare's "Era 1" revolved around the idea of medicine as inherently good and requiring self-regulation, Berwick, president emeritus and senior fellow at the Institute for Healthcare Improvement, writes in a commentary for JAMA. However, as it became apparent that the healthcare system had inherent flaws and contradictions, such as racial and class disparities, the movement gave way to "Era 2," our current stage. Era 2, Berwick writes, emphasizes measurements, accountability and financial incentives.
"Era 3" of healthcare, he writes, must include features of both. To achieve this vision, he says that the industry must require:
Less mandatory measurement: One of the main problems with Era 2, Berwick writes, has been overreliance on measures, many of which are of limited usefulness. In the future, measuring bodies must work to cut the cost and volume of healthcare measures by half over the next three years.
Simplified incentives: Measures must also emphasize standardized triple-aim focused goals and incentives rather than confusing, easily manipulated complex incentives for individual clinicians, Berwick writes.
Quality over revenue: Echoing the federal government's strategies, Berwick calls for healthcare to move away from strategies that focus only on maximizing revenue, which he says is unsustainable in the long term. To properly emphasize care quality, he writes, care improvement must be a core competency for healthcare leaders.
Complete transparency: "The right rule is: 'Anything professionals know about their work, the people and communities they serve can know, too, without delay, cost, or smokescreens,'" he writes.
To learn more:
- read the commentary (subscription may be required)