Texas Tech University Health Sciences Center
Our Health Care Era

Our Health Care Era

I have always enjoyed reading what former Centers for Medicare and Medicaid Services (CMS) administrator Donald Berwick, M.D., has to say. Dr. Berwick, president emeritus and senior fellow at the Institute for Healthcare Improvement, is a very thoughtful person, in my humble opinion.  I have been following Dr. Berwick’s career for years and recently read his new commentary in the Journal of the American Medical Association (JAMA).

He described three “eras” in health care.  The first, which he calls “Era 1,” is rooted in antiquity and revolves around the idea of medicine as a noble calling that is understood by those with special knowledge and training and requires self regulation. This entails the idea that medicine has the right to judge its own work. While self-regulation sounds appealing, Dr. Berwick wrote that this phase created disparities, variation in practice and a host of other problems.

The next era, which he appropriately calls “Era 2,” replaces much of the self-regulation with regulation through measurements, accountability and financial incentives. It is where we are today. But, he thinks that we may have gone a bit overboard with all of the measurement and he is concerned that the value of some of the measurements is dubious. He also states an often-heard complaint that many physicians are frustrated with all of the “control” that seems to surround them.

So, what is the answer?

This will not surprise you, but he says we need to go to "Era 3," which entails characteristics of the first two, but with a twist. He wants to eliminate the protectionism of “Era 1” and the mechanical measurement of “cook book” medicine from “Era 2”. He thinks that basically we need to simplify health care by using fewer measurements and offering incentives that are easier to understand.

He would also like to see emphasis placed on the “Triple Aim,” which is improving the patient experience, improving the health of a population and reducing the per capita cost of health care.  Certainly, these are good things to pursue. I had to boil his article down to its basics, but this is what I got out of it.  You can read the entire article for yourself, and I definitely recommend it.  Have a great week!

Brent Magers, CEO