Anna M. Roth, CEO of Contra Costa Regional Medical Center and Health Centers in Martinez, Calif., spoke with Edward Prewitt, NEJM Catalyst’s Editorial Director, about the findings of the first Catalyst Care Redesign survey and report.
On the top barriers to improving the value of care:
“It depends on the lens you apply.” The top responses to this question “reflect a combination of patient engagement and the fee-for-service payment structure. It’s really important to step back and understand what we mean when we say ‘value.’ I think most people in health care are thinking about finances, but patients are thinking about their quality of life and the ability to engage in things that matter to them. Most of the time we’re asking this question of clinical people or of health leaders, but if we ask patients what is important to them, I think you would see a shift in this chart. . . . The health care industry believes value has to do with return on investment. That’s true, but it cannot be decoupled with what matters to the patient.”
“In looking at the overall report, you saw that in the [respondent] comments and in the discussion, there is a balance between population health approaches and the person in front of you. Those things can’t be separated. In the coming years the top performers will be those systems and clinical folks who really understand how to implement the balanced approach.”
On designing a health care system to remove these barriers to improving the value of care:
“When I was heading back from the IHI [Institute for Healthcare Improvement], returning to my organization and realizing I was going to have this leadership responsibility as CEO, I had a series of conversations with Dr. [Donald] Berwick [then president of IHI]. I asked him, ‘What is the most important thing for me to focus on?’ As the CEO, you’re tasked with setting the vision for your system and then actually implementing it. He said, ‘You need to find out what the patients in the community need you to be, and then you need to be that.’ What this means is you need to really learn how to understand what is happening with the population in your region. And then you need to meet their needs individually.”
“What I want [as a patient] this year could be very different from next year, and I want my health system to be able to adapt to that. We need to have an ability to deliver reliable care in a standardized manner, but also with a sensitivity and ability to understand what matters to patients when we’re encountering them. That isn’t easy to do. What that turns into is trusting in your frontline people to make decisions, and providing them with the right tools to make those decisions. Make sure your policies don’t get in the way. This is with the assumption that we are nesting delivery of our services in science, but in a way that is sensitive to the needs of individual patients.”