Delivering High-Quality, Affordable Care in Family Practice

This is the text of Secretary Burwell’s speech at the AAFP 2014 Assembly, as prepared for delivery.

Thank you, Dr. Henley. It’s great to be here with all of you.

Having grown up in a small, rural community in West Virginia, I’ve seen firsthand the ways in which family medicine is the soul of a small community. Dr. J.D. Woodrum, who delivered me and was my primary physician into my 20s, also served on the County Board of Education, was a family friend and pillar of our community. I remember once in my 20s being grilled about a boyfriend at college my mother had happened to mention. God rest his soul.

So I want you to know that I understand the special role you play in your communities and in the medical profession. You are the patient’s advocate. You are the first person they call when they feel sick or have a question. You bring your patients into the decision-making and guide them through the maze of treatments and specialists. When there are choices to be made, you offer clarity, conversation and compassion.

I think we’d all agree that this is exactly what we need more of in our health care system.

Since President Obama signed the Affordable Care Act, we’ve come a long way as a country in terms of affordability, in terms of access, and — yes – in terms of quality.

I wanted to come see you today, because there is more we can do to improve quality and spend our health care dollars more wisely.

And I believe we have a shared purpose: You and your fellow family physicians — like other primary care specialists – represent so much of what’s right with our health care system. I’ve come here today to ask for your help in bringing your style of quality care to more patients in more places.

I know that you provide quality care because you care — and I know this is what inspired you to go into medicine. You care for people, and you care about people. You care about the quality of care your patients receive — and by extension, the quality of life in your community. You care about serving folks who would otherwise go unserved or underserved.

These are our priorities, too. I hope we can leverage our shared purpose to form a strong partnership. Because we have a tremendous opportunity to work together to deliver impact that benefits patients, physicians, providers, businesses and taxpayers alike.

With this in mind, I thought I’d use this opportunity to tell you a little bit about what we’re doing at HHS around these issues and how we hope to work together. I also want to give you an update on a couple of timely issues — the first being Ebola, and the second being Open Enrollment, which begins in 23 days (not that I’m counting).

Ebola

Let’s start with Ebola, which I know is top-of-mind for all of us. Like you, I have been keeping the patients currently being treated and their families in our thoughts and prayers.

From both a public health and a national security standpoint, Ebola is a top priority of this Administration.

We’re taking a “whole of government” approach to responding at home and abroad.

A central part of our preparedness here at home is ensuring that all hospitals are in a position to manage the early recognition and isolation of a patient and engage public health authorities appropriately for early treatment of a patient.

As part of that, we’re asking that hospitals have a rigorous preparedness plan.

We’ve ramped up outreach to hospitals and front-line health care workers to “Think Ebola” and “Care Carefully.” That means screening and identifying potential cases by asking a travel history; isolating potential cases, using appropriate personal protective equipment, and activating the hospital preparedness plan.

We are also focused on being sure our health care workers are trained and kept safe.

Today, I want to ask you for your help in making this happen. We need each of you to educate yourselves on CDC’s materials and recommendations so that you can identify potential cases. We can also use your help to work with your health care facilities to conduct one or more Ebola “Grand Rounds” for doctors and nurses, as well as first responders, lab workers, and even waste disposal folks

As physicians, you know that this is a difficult disease to catch. It is important for Americans to know this. You might have heard the President himself talk about how he has met and hugged some of the doctors and nurses who’ve treated Ebola patients.

You also know that we have the public health infrastructure in the U.S. to stop the spread of the disease.

The final point is that the best way to protect Americans here at home is to stop Ebola abroad. We have teams from HHS, from CDC and from the Commissioned Corps of the U.S. Public Health Service on the ground along with personnel from USAID and the U.S. military, who are working with local authorities. We are committed to contributing to the worldwide response. And we are committed to protecting the health and safety of the American people.

How We Got Here

Switching gears a bit — I wanted to share a few thoughts on improving health care delivery. I continue to be very optimistic about the opportunities ahead of us to work together.

One of the reasons this is a priority for all of us is that the health delivery system that’s been in place for the last 50 years has under-delivered on affordability, access and quality.

You could almost sum up the past half century in a sentence: The prices we paid far outpaced the progress we made. Health care costs grew significantly faster than things like GDP and middle-class family incomes — and we all felt the effects of a system that did not spend our health care dollars as wisely as it could have.

Moms and dads felt the effects as they sat down at the kitchen table to work out their family budgets. Businesses felt it on their balance sheets. And you felt the heartbreak of patients who could not afford the care they needed.

Not only did we pay more, in some cases we also got more, too, but sometimes we got more of the wrong things: more unnecessary tests, more preventable readmissions.

Parts of our system simply did not make sense. We waited until patients got sick in order to treat them, rather than focusing on prevention. Our payment models incentivized volume and quantity rather than value and quality.

Progress to Date

This is where we were. Then, in 2010, Congress passed the Affordable Care Act and President Obama signed it into law.

We’ve now held down health care price inflation to the lowest rate in 50 years.

We’ve saved taxpayers $116 billion through improvements we made to Medicare health delivery among other changes.

Last year, we drove down Medicare hospital readmissions nearly 10 percent.

Between 2010 and 2012, our country drove down patient harms 10 percent — saving 15,000 lives and driving down costs by $4 billion.

And the Accountable Care Organization Models we’re testing are benefitting 5 million patients. The quality of care is high, patients report that they’re happy with their care, and taxpayers are saving $370 million and counting.

Spending Dollars Wisely to Deliver Higher Quality Care

At HHS, we have a term for this kind of progress: “a start.”

Today, as Family Medicine for America’s Health rolls out its vision, I want to share mine:

I believe that as Americans, we will receive better care — and spend our dollars more wisely –if we find better ways to deliver care, pay providers, and distribute information.

To drive progress on these goals, we’re focused on supporting you, as you find new ways to coordinate and integrate care. We’re focused on engaging patients more deeply in decision-making. And like you, we’re also focused on improving the health of our communities — with a priority on prevention and wellness.

When it comes to improving the way providers are paid, I want you to know that we share your commitment to rewarding value and care coordination — rather than volume and care duplication. Like you, we want to pay providers for what works – whether it’s something as complex as preventing or treating disease or something as straightforward as making sure a patient has time to ask questions – areas where Family Medicine is leading the way.

In addition, as we look to improve the way information is distributed, we’re working to create more transparency on cost and quality information, to bring electronic health information to more places, and to bring the most recent scientific evidence to the point of care so we can bolster clinical decision-making.

We know Medicare and Medicaid are the two largest health insurance plans in the world. Together they cover roughly 1 in 3 Americans. So one of the things we’re doing is identifying the grant and rulemaking opportunities — and finding ways to use them appropriately to improve the quality of care that beneficiaries receive while spending dollars more wisely.

The bottom line is that we understand that it’s our role and responsibility to lead, and we will.

What we won’t do — and can’t do – is go it alone. Patients, physicians, government, business – we all have a stake. And I believe that this shared purpose calls out for deeper partnerships.

We want to work with you to change the way care is delivered, recognizing that you are the experts — it’s physicians like you who drive progress.

Announcement: Transforming Clinical Practice Initiative

With this in mind, today, I am announcing a major investment to move these goals forward: a first-of-its-kind, $840 million “Transforming Clinical Practice Initiative” that will provide grants to organizations who are working directly with medical practices as they rethink, redesign and reimagine their own systems. This investment is designed to support more than 150,000 clinicians in their work on transforming practices for the better. It is designed to improve health outcomes for millions of patients and their families. It is designed to spend taxpayer dollars more wisely. It is designed to reward value.

We want to partner with those who are working to improve the coordination of care — both inside and outside their offices – and we intend build networks of clinicians who learn best practices from each other, and build new networks.

We want everyone who is willing — large, medium and small practices – to be able to practice medicine with a focus on quality. We want them to be able to engage their patients more deeply in their own care, and make it so they are more likely to stay out of the hospital because they are healthy.

Now, here’s what this is not about: We’re not seeking to impose reforms from the top down. We want to help you innovate. And we can draw inspiration from physicians, providers and medical professionals all over the country who are doing just that.

Open Enrollment

Now, ultimately, in order to make progress on quality, we also have to keep moving forward when it comes to access and to affordability — and so I have another ask of you.

Your patients, your neighbors and your family members look to you as people they can trust. As family physicians, you know how hard it is for your patients when they don't have insurance or have coverage that's unaffordable or runs out just when they need it the most.

I know that you've all done the best you could in system where, for far too long, too many of the people you served were either uninsured or underinsured …

A system where too many Americans relied on the Emergency Room for medical care …

Where too many went without basic preventive services, like immunizations and yearly check-ups …

And where too many middle-class families had to live knowing an unexpected accident or illness could cost them their home or wipe out their life savings. So the Affordable Care Act is a tremendous opportunity for all of us. As you know, the next Open Enrollment period begins November 15^th and runs through February 15^th.

I like to say this round is really the first full round of Open Enrollment, because we've got all of the people who signed up last time who we want to renew their coverage — and we've got millions of Americans we want to enroll for the first time. So this year, we're going to need your help and your support just as much as we did last year – if not more.

I know many of you are treating patients right now who are newly insured, some of whom might not have had insurance in the past. So, we hope you'll encourage them to stay covered. And we hope you’ll encourage any uninsured patients to go ahead and take that important step and get covered.

Conclusion

I want to invite you to close your eyes just for a moment and think about why you got into medicine.

I’d be willing to wager that you chose family medicine because you believe in being close to your patients. You want to help them with prevention. You want to help them manage their illness and chronic disease. And you want to make your communities healthier places.

This is our shared purpose.

And at the end of the day, it’s not about making a point, it’s about making progress. Physicians and patients are tired of the back-and-forth. They just want to move forward.

My friend Atul Gawande once wrote: “Better is possible … It takes diligence … It takes … clarity. It takes ingenuity. And above all, it takes a willingness to try.”

I am asking for your diligence. I’m asking for your ingenuity. And I’m asking for your willingness to join us in building a better health care system.

I look forward to being your partner.