Thursday, October 30, 2008

Outsourcing the Leadership of HHS and CMS?

The Disease Management Care Blog has had a chance to reflect on the October 17 Washington D.C. ‘Patient Centered Medical Home Summit’ that was hosted by the Patient-Centered Primary Care Collaborative (PCPCC). It thinks the highlight of that confab was the twin Working Lunch speakers, the Honorable Brit, Gerald Malone, who served as the ‘Minister of State’ at the UK’s Department of Health and Dr. Bernat Soria, the current Health Minister of Spain.

Both speakers charmed the otherwise suspicious DMCB.

The ever proper and self deprecating Mr. Malone used a classic wry sense of humor to regal the luncheon attendees about how he traveled around the country talking to countless physician groups to get them to buy into the latest government scheme. What was that scheme? The DMCB can’t remember and it bets the physicians he spoke to don’t remember either. What is memorable is the considerable effort taken by a government minister to get buy-in from the docs one buffet-dinner at a time.

Dr. Soria was a heavily accented bespeckled academic technocrat. His smiling demeanor spoke volumes about his belief in Spain’s socialized medical system. While the physician DMCB wanted to be hostile over that apostasy, it was rebuffed by Dr. Soria’s emphasis on his country's belief in primary care. Close to 70% of Spain’s health care encounters begin and end in its primary care system. His country’s goal is to increase that to 80%.

Days later, while the DMCB was contemplating its two pound weight spike thanks in part to the excessively dense PCPCC luncheon dessert of dubious pedigree, it came across the Commonwealth Fund’s Karen Davis’ latest New England Journal of Medicine sermonizing on But For Lessons The USA Should Import From Europe, Lives Would Be Saved. They include the Brit’s ‘National Institute for Health and Clinical Excellence (NICE)’ Denmark’s electronic record system, the Netherland’s use of non-physician providers, Germany’s pricing of pharmaceuticals and bundled payments and all the Europeans’ no nonsense approach to non-partisan solution-seeking.

The DMCB isn’t so sure. It has a belief in the uniqueness of American civilization, a lingering cultural antipathy to central planning and a view that the U.S.’s health care needs can only be partially met with the evidence-based medicine, electronic records, non-physicians and government planning. It thinks reform will take more, that the solution will have to be uniquely American and that Americans will not embrace change until they see it as their own.

How then, does the DMCB reconcile its admiration of Mr. Malone and Dr. Soria with its Tocqueville-esque belief in American exceptionalism? Maybe it was the dessert’s methylxanthine induced nighttime relux, but the DMCB’s eventual epiphany was that Mr. Malone and Dr. Soria’s successes were the result of their interpersonal skills combined with considerable effort at local outreach.

So here’s the real lesson from Europe: it’s not only a matter of formulating the right policy and legislation, it’s a matter of competent and locally relevant leadership. Ms. Davis misses that from her perch in D.C. Maybe the one 'exception' to the DMCB’s belief in American exceptionalism is the option of outsourcing the leadership of HHS and CMS to Dr. Soria and Mr. Malone, respectively.

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