State’s largest health insurer offers plan to cut costs, improve service

Here are nine steps, Berwick outlined in his presentation, and will be used by Horizon as broad guidelines going forward:

Avoid too much measurement. “We need to tame measurements,” Berwick said, referring to the healthcare system’s over-reliance on medical studies and reports when treating patients. “This country’s gone mad with measurements in healthcare. Doctors, nurses and hospitals are spending billions in generating and responding to reports that help no one at all. Measurement should be a servant, not a master.”

Eliminate complex incentives for doctors. “We need a moratorium on complex incentive programs,” Berwick said, referring to monetary incentives that doctors can claim if they meet certain patient and outcome quotas. “If incentives are too complicated to act on in order to deliver better service, then it isn’t an incentive program, it’s a computer program,” Berwick said.

Focus less on saving money. “Healthcare is about improving the match between the work you do and the need you’re trying to meet,” Berwick said. “The best route to financial success is not cutting costs, it’s improving the quality of service. That’s a fundamental tenet in business, and it needs to be in healthcare as well.”

Give up professional prerogatives at the expense of the whole. Berwick said that doctors need to work with patients more closely and give up their authoritative attitudes.

Recommit to improving science for modern methods. Berwin said that the U.S. healthcare system needs to be more open to change. For example, he said, the British adopted a new system after a study several years ago introduced scheduling approaches that dramatically cut down on delays and wait times at both doctors’ offices and hospitals. “This is about trying new approaches, techniques and technologies to improve processes,” Berwick said.

Enhance Transparency. Berwick emphasized that hospitals, doctors and administrators need to be more transparent in everything they’re doing. “You can’t have improvement without transparency,” he said.

Protect civility. Debate over how to improve the healthcare system needs to be civil in order to arrive at workable solutions, Berwick stressed. “Everything possible begins with civility. The accusatory postures don’t serve us well.”

Listening to the patients’ needs. “Listen, really listen to your patients,” he said. “Navigate care toward the needs of patients.”

Reject greed. “For whatever reason, we have shifted in this industry toward levels of greed,” Berwick said. “Pharmaceutical companies charge outrageous prices for irreplaceable drugs just because they can. Hospitals consolidate and then jack up prices through market leverage just because they can. That has to stop and we have a duty to stop that and to protect and declare moral values that underlie healthy communities.”