Hospital CEO's Battle With Diabetes Offers Insight Into Reform

As Dennis D. Keefe, CEO of Cambridge Health Alliance, struggles with his personal health problems, he's gained a new understanding of how complicated and difficult real reform will be:

It looks like Congress will soon pass a health care reform bill and send it to the President before the end of the year. However, “stabilization,” rather than “reform,” might more accurately describe the bill’s goal as the government tries to get better control of its health care spending.

Real reform doesn’t come from a single bill or signature. While our state’s landmark health insurance access law has insured an astounding 97.3 percent of residents, it nevertheless has done little to control spiraling costs. We’re already on to Phase II by considering a radical change to the way physicians and health care providers are compensated. This may ultimately be an even more substantial transformation, yet still may not signify true reform.

Real reform requires a massive societal attitude change and a realization of our true goals.

I pondered this over the summer while dealing with personal health issues. Diagnosed with Type 2 diabetes several years ago, I was given the traditional regimen of medications meant to alleviate and slow the advancement of this progressive disease. The medications - four in all - worked well at first and like millions of other diabetes sufferers I felt I had been given the magic bullets necessary to combat the disease. I could still eat whatever I wanted, and added only small doses of exercise to my daily activities.

Over time, though, my hemoglobin A1-C count - the true indicator of how well one’s diabetes is controlled - showed I was losing the battle. More aggressive treatment was needed.

But that didn’t mean more magic bullets or medication changes. It meant actually listening to my doctor. It meant truly changing my lifestyle. Now, after losing nearly 30 pounds and embarking on a healthy diet and exercise regimen, I’ve cut my need for medication by half. My goal is go completely off the meds within the next six months.

Buying fewer drugs, visiting my doctor less frequently, and generally spending less to stay healthy runs counter to how we approach health care.

And yet mounting evidence tells us that there may be no correlation between the money spent on health care and the quality of that care and its ability to prevent disease. There may even be an inverse correlation. How else to explain that the US spends more on healthcare per capita than any country yet doesn’t place in the top 30 in rankings of overall health system performance?

The true promise of health care reform is a transformation to a system that prevents disease more than it treats it. There’s plenty of money in the system, we just aren’t spending it correctly, or aiming it at the programs that produce the best results. We must find ways to provide financial incentives to physicians and institutions for treating fewer patients and for generating more positive outcomes. We must dedicate more public money to prevention. We have to bring new ways of thinking to the table that incorporate all disciplines and philosophies.

For example, absent from the current health care debate is any discussion of our current food supply and the way we eat. Dr. Christina Economos, an associate professor at Tufts University, who is the principal investigator in a groundbreaking study on obesity in Somerville, said recently that the US must make agriculture a major part of the debate. Her study, “Shape Up Somerville: Eat Smart, Play Hard,” proved it is possible to reduce excess weight gain in children through changes at many leverage points in communities.

It may seem strange for a hospital CEO to be envisioning declining patient volumes. But that’s the point. If we are to really succeed with reform that lowers costs as well as improves outcomes, physicians and other clinicians will have to become health educators and hospitals and clinics will be wellness centers. Physicians/clinicians with whom I speak are tired of this treadmill of production (visits, RVUs, admissions) that is more focused on income generation than in doing the best thing possible for patients and families. Most are willing to embrace a new future and are actually excited about the prospects.

We can all rejoice and congratulate the President when he signs his health care bill, but we have to remember that it only marks the beginning of the conversation and merely hints at the true promise of reform.