Cincinnati Children's Blog

Berwick II: Health reform not for the faint of heart

Don Berwick, President Obama’s choice to lead the Center for Medicare and Medicaid Services, faces many challenges. Transformation of health care is not for the faint of heart. But there is very good evidence that the reduction in cost and the simultaneous improvement in quality can, and should be, tackled at the same time.

Uma Kotagal

As we have seen in creating and growing a culture of safety and quality at Cincinnati Children’s, the biggest challenge is the transition period from where we are to where we need to move. It will be hard and it will not happen overnight.

Shifting the alignment of financial drivers and rewards from the current focus on utilization and activity to a focus on outcomes will require patience and a sense of urgency.

Berwick knows that cost reduction must be partnered with quality improvement. If cost is reduced willy-nilly without improving quality, we are likely to see significant negative effects.

One major obstacle facing Berwick as he attempts to transform health care is the drive to reduce consumption without compromising quality. It’s a challenge, but it is eminently doable.

He knows this because he has seen what Cincinnati Children’s (among others) has been doing for the past 13 years. In every instance, by focusing on the outcome, aligning the resources, reliably improving key processes, hard wiring it into the electronic medical record and putting the patient and family in the driver’s seat, we have achieved a  stellar record of cost reduction and improved quality, i.e. reduced errors and infection rates.

Berwick’s new job will put him at ground zero for reforming the health care system. It will extend far beyond Medicare and Medicaid. The health reform bill calls for changing the way we pay for medical services. The hope is to force providers to change their behavior by focusing on real quality with real improved outcomes. The government would save money. Everyone else would, too. The quality of care would actually improve and patients – all of us – would be better off.

Berwick understands this mission. He believes in it. And we believe in him.

Uma Kotagal, MBBS, MSc, is Senior Vice President of Quality, Safety and Transformation and the Executive Director of the James M. Anderson Center for Health Systems Excellence at Cincinnati Children’s. Dr. Kotagal oversees the development of disease management teams and development of evidence-based clinical practice guidelines at the Anderson Center. 


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