Health Care Task Force Starts Up

by David Gorn

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This is not your usual task force, according to Diana Dooley, secretary of the state Health and Human Services department. This one, she said, is less interested in the ideal and more focused on producing real-world results. The idea is to figure out which programs across the state improve health care and keep costs down and then encourage and support them.

Dooley was in Los Angeles yesterday to co-chair the first meeting of the health care task force created last month by Gov. Jerry Brown (D). Dooley said the first gathering could not have gone much better.

"I thought it was energized, and energizing," she said. "It went a long way toward really substantively addressing a meaningful plan, to see what it would look like for California to be healthier in 10 years than it is today. And how do we make some real changes to improve health, lower cost and reform the delivery system. I thought it was a great start."

Designed for a short lifespan with specific goals, the task force targets one of biggest challenges facing the state, Dooley said.

"Having a road map is really important," Dooley said. "It's important that this is a short-term, focused group, and that this would result in a plan that would be usable to a lot of people."

Don Berwick, former CMS administrator and past president and CEO of the Institute for Healthcare Improvement, is co-chair. He said the real goal is to improve health care and that when care is provided more efficiently it ends up saving money as well.

"Health care costs are a driving force behind the economic turbulence in California and the nation," Berwick said. Fixing that, he said, "can't be done passively. It has to be done through better care. Not by cutting things, but by focusing on what we value, and better health is the key to the castle."

Managed care may be part of that equation, but not a solution, he said. "You have to have some form of coordination, especially for people with chronic illnesses," Berwick said. "I suppose you could call that managing care. We need to manage our work on behalf of the patient."

The idea, Berwick said, is to short-circuit the endless repetition of chronic-condition crisis and intervention. For instance, a diabetic can properly monitor and control diabetes with provider help, or a patient can repeatedly end up in the emergency department with a diabetic crisis.

"They have to be the right kind of trips to the doctor," Berwick said. "That is, [trips where] you're paying attention to proper nutrition up-front, and putting resources into prevention. It's a redistribution of effort, and the payoff is phenomenally high."

The change has to be a systems change, he said. "Right now, we're in a revenue-driven payment system, so that means we have unsustainable care. As long as we're in a volume-based system, that will be the case," Berwick said. "When we get to an excellence-based system, that's the best thing for our wallets, and for our bodies."

Dooley said that kind of change starts with tapping into the brightest minds in the public and private sectors of health care, and mining the best programs in use in California, the ones that work under current budget constraints.

"It's the old line: Crisis creates opportunity," Dooley said. "We need to improve access and improve quality at the same cost, using the spending we already have. This will not be a plan that sits on a shelf. The idea is very powerful, to create a road map people can use to make actual change."


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