A Report from the Front Lines

One of the problems with reformers in Washington is how little time they spend with professionals who actually deliver health care every day. One of the benefits of my travels as a speaker is interacting with real caregivers on a regular basis. Last week, I had the pleasure of working with 75 members of the California Healthcare Leaders Network (http://futurehealth.ucsf.edu/Public/Leadership-Programs/Home.aspx?pid=145) sponsored by the California Health Care Foundation (www.chcf.org).


The participants in this forum—all clinicians by background—are exemplary professionals in the day-to-day business of meeting people’s needs for care and cure throughout California. They are Chief Medical Officers of delivery systems large and small, Chief Operating Officers with doctoral degrees in nursing and pharmacy, leaders of quality assurance programs for major health plans, directors of Community Health Centers, full-time primary care practitioners, etc. You and I would be happy to have any of them as our caregivers. They represent the best in American medicine—the exact opposite of the maligned providers many politicians want to reform.

These front-line professionals come together several times a year to hone their leadership skills, to network, and to share thoughts about improving the delivery of health care. After 12 hours of intensive interaction with them, I was thoroughly impressed with their commitment to producing top-quality care at lower cost for more residents. I did not hear a single comment suggesting their objective was to earn more money or turn the system to their personal advantage (common themes in medical meetings in the not-too-distant past).

Rather, I heard them express heartfelt frustration about numerous roadblocks that prevent them from taking the time to work with patients whose needs require more attention than the current system allows them to give. These caregivers wish that our health system’s resources could be redirected toward patient-centered medical homes, prevention, chronic disease management, accountable care organizations, and other reforms that would actually improve delivery of health care in the United States. They wonder how aspirations to build a world-class health system got derailed into narrowly focused insurance overhaul in less than a year.

How I wish the powers-that-be in Washington would spend quality time with real professionals who are trying to solve real problems on the front lines of the battle for health care! These clinical leaders from California have great ideas…and they ask hard questions about what can be done to rid our system of the perverse incentives that get in the way of doing what really needs to be done. How can we redirect health reform toward building a really good health system, regardless of the outcome of the “Hail Mary” play that the Democratic leadership is planning to run within the next few days? Please help answer their question by adding your comments.