What's a health trend that you wish would go away?
The health care system continues to focus disproportionately on "care" at the expense of "health." Because Medicaid does not generally reimburse for social workers, case managers, or community health workers under the prevailing "fee for service" payment structure, each clinic must carve out precious discretionary funds from its operating budget for this purpose—resulting in limited capacity to address the real factors impacting patient health.
The challenge becomes self-perpetuating. Overburdened case management staff focus on crisis cases, lacking the time and capacity to attend to other patients and document their needs (and resolutions of their problems). Absent this data, it is impossible to build the business case for these activities.
Over the past two years, certain forces have been set in motion that create an unprecedented window to redefine what the U.S. health care system pays for and thus the scope of care provided. I would like to see a system that is willing to make preliminary investments in interventions that stretch the boundaries of what we currently understand as health care.
What's an idea you became fascinated with but that ended up taking you off track?
When Health Leads launched in 1996, the notion of obesity and asthma epidemics was just creeping into the public consciousness. At the time, Health Leads created and implemented novel disease education programs for youth with asthma, diabetes, sickle cell anemia, and other chronic medical conditions. While popular with our volunteers and physician partners, the programs did not yield the compelling, cost-effective results necessary to justify their costs. Eliminating these programs was a painful decision, but ultimately empowered us to focus our resources on the work of creating patient resource connections and to be as deliberate about what we choose not to do as what we choose to do.
Who are three people in the fields of medicine or public health that you'd put in a Hall of Fame?
Dr. Atul Gawande: An extraordinary narrative storyteller for the health care field, Dr. Gawande makes the opaque and arcane aspects of health care comprehensible to the public, policymakers, and thought leaders alike. When we are tempted to turn and run from the onslaught of the health care debate, he coaxes all of us back into the conversation.
The Mayo Clinic Center for Innovation Team: In 2008, the Mayo Clinic made the unconventional move of hiring a team of architects, graphic and product designers, and other systems thinkers to re-imagine health care delivery. Already, this team has produced innovations that could dramatically alter the way all patients experience health care.
Dr. Barry Solomon, Medical Director at Harriet Lane Clinic, John Hopkins Children's Center: One of my mentors often says, "Ideas don't change the world. Execution does." Dr. Solomon's tenacity in translating the concept of a medical home into front-line clinical practice is unparalleled. His in-the-trenches tactics—such as ensuring that providers complete Health Leads's patient resource needs screening tool by stapling it to the patient billing sheet—exemplifies the kind of leadership necessary to change health care delivery.