Wednesday, June 4, 2008

HHS Secretary Leavitt Quotes: Legacy Building, P4P, Networks and Others

One of the Disease Management Care Blog’s favorite WSJ columns is called The Middle Seat. It was reminded of that because that is precisely where it is destined to be once it gets out of the Red Carpet Lounge today in O'Hare. That isn’t so bad, because that'll be a chance to catch up on a lot of reading. In the meantime, kudos to the Lounge for no longer charging for wireless internet access.

On the way out to Chicago, the DMCB made a head start by looking at the print version of the Health Affairs 'Web Exclusive' wide-ranging interview of HHS Secretary Mike Leavitt. The DMCB didn't detect any particular overarching theme in this read, but this does make for some interesting quotes. They give good insight into this very smart Secretary's point of view. Furthermore, perhaps one of these nuggets can be used in a DMCB reader's future PowerPoint presentation:

Never mind the 80-20 rule. In the public sector, it’s the ’40-40-20’ rule. ‘Success is 40% what you decide to propose, 40% is now you describe it and 20% who you tell in advance of proposing it.’ That may be true in parts of the private sector too. The DMCB recommends that readers keep that last 20% in mind if they ever get a call from HHS.

Secretary Leavitt learned from the Olympics that what happens long after the games are finished is what is important: ‘And I took my 10,000 day horizon and said, where do I want this to be 25 years from now.’ Think about the big commitment to information technology and value based purchasing and it makes sense. This is an interesting contrast between notions of short-term political expediency and long-term legacy. Really long term legacy.

Here’s an interesting example of applying the realities of the government calendar to an initiative like the American Health Information Community (AHIC): ‘The executive order gave the group a two year life because we wanted to transition it to a successor organization….The government runs in four-year cycles, but its really not four years. Because when it starts, there’s about a 6 month period when no one’s in place… then the last year, there’s an election.’ For those readers wondering why things don't get done quickly or are calling campaingn staffers offering to be in the next McCain or Obama Cabinet, this is sage advice: if it doesn’t happen in that two year window, forget about it.

There’s a new social phenomenon afoot everywhere called ‘networks’ (maybe a spill over from military thinking: consider Israel and it's star-crossed foray into south Lebannon) that should be recognized as the emerging health care paradigm: ‘So as you start to approach the way health care needs to work, it should work more like a network of PCs rather than a mainframe. Now, Medicare and Medicaid and big socialized insurance programs are still mainframes.’ Maybe the DMCB should change its naming of 'Coordinated Delivery Systems’ to Networked Delivery Systems.’ The underlying principles are the same, but it sounds cooler, more informationish techoid, don’t you think?

Here’s a reality dose for pay for performance: ‘We are not very good at the basics [but] we need to do this…. What we’ve got is a little pile of wheels and a small chassis and a Briggs and Stratton motor… We’ll do it by creating a little go-cart that evolves into a race car.’ Putt..putt… vroom!

How do you run an organization with a $750 billion budget and 67,000 employees? ‘Twenty seven people report directly to me. I have no undersecretaries.’

As an aside. the interviewer was Leonard Schaeffer, formerly of WellPoint. Check out his brief quote that tells volumes about IT, the physicians and 'the system': 'We received awards for attempting to accelerate health IT adoption, but the truth was, we tried and failed. WellPoint gave away $42 million worth of hardware and software to doctors, many of whom happily took their laptops home to their kids. All we got from that effort was a letter from the California Medical Asociation (ed.comment, an autonomous physician association that participates in the AMA) accusing us of unfairly imposing a gift tax on recipients of free IT supplies.' He makes a good point: if physicians are given monetary or other services in kind to support IT or the Medical Home, what assurance is there that they will not fail to invest the resources in the kinds of improvements necessary to improve quality and reduce cost? Will some docs will be tempted to take the money and run, while continuing dysfunctional one-on-one care?

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