December 1st was Don Berwick’s last day as the administrator of the world’s largest health insurance entity, the Centers for Medicare and Medicaid Services (CMS). Dr. Berwick was responsible for an $820 billion agency that cares for 47 million Medicare beneficiaries, 39 million over the age of 65. Although trained as a pediatrician, Berwick was keenly aware of the special needs of our nation’s older adults. Much of what he did at CMS will have an enduring impact on the health of older adults. Here at the John A. Hartford Foundation, we believe Don would have made an outstanding geriatrician. Considering our expertise in the area of older adults and health, I think we can confidently say we know one when we see one. As Don rejoins the health care rank and file, we want to recognize his significant achievements.

Dr. Berwick reorganized CMS around innovation and the fundamental desire to achieve the three-part aim: better care, better health, lower costs. The phrase was notably coined by Berwick while at the Institute for Healthcare Improvement. Under his tenure as CMS Administrator, it became the true north for health policy implementation. The three-part aim was central to CMS launching the demonstrations outlined under the Affordable Care Act, aimed at realigning incentives through shared savings. Examples include the Accountable Care Organization, described by Chris Langston in his blog, Everything You Wanted to Know About ACOs but Were Afraid to Ask, and the Community-based Care Transitions Program that Eric Coleman and I wrote about in Health Affairs (see GrantWatch Features Care Transitions).

But Don’s vision went far beyond mere policy implementation. He foresaw a better, safer American health care system, and pointed the way with a national safety road map, known as the Partnership for Patients. The two goals of this public-private partnership are to:

  • Keep patients from getting injured or sicker. By the end of 2013, preventable hospital-acquired conditions would decrease by 40% compared to 2010. Achieving this goal would mean approximately 1.8 million fewer injuries to patients with more than 60,000 lives saved over three years.
  • Help patients heal without complication. By the end of 2013, preventable complications during a transition from one care setting to another would be decreased so that all hospital readmissions would be reduced by 20% compared to 2010. Achieving this goal would mean more than 1.6 million patients would recover from illness without suffering a preventable complication requiring re-hospitalization within 30 days of discharge.

Behind the scenes and within the beltway, Don also raised the bar. For the first time, agencies within HHS came together to strategize how they would contribute to these common aims. Within CMS, folks met weekly as an agency. The many strong soloists at CMS became members of a singular choir.

Through the Center for Medicare and Medicaid Innovation, Dr. Berwick announced the Innovation Advisor Program to create leaders skilled in implementing innovations that measurably achieve better care, better health, and lower costs. We at the John A. Hartford Foundation know the value of leadership development, having witnessed firsthand the impact that leaders developed through Hartford Foundation-funded efforts such as the Practice Change Fellows Program and the Geriatric Nursing Leadership Academy have had on health care delivery.

But perhaps Don’s greatest impact will be his determination to place patients at the center of care delivery. Many of you have read the blogs about my treatment choices with stage IV breast cancer. Don has long advocated that we need to treat the patient, not just the disease. He said, “We have really good data that show when you take patients and you really inform them about their choices, patients make more frugal choices. They pick more efficient choices than the health care system does.” With the number of older adults fast approaching the doubling point, we need to consider how to support the goals and values of the most vulnerable patients at the end of life.

For all Don Berwick’s accomplishments while at CMS, and the many more to come as he returns to “civilian” life, I raise my glass. Here’s to you, Don.