Talk less, do more: Let’s start a movement in health care

Ideas in the ‘Vital Directions’ report are sound, writes Dr. Eric B. Larson. But we need a movement to reach our destination of quality care for all

by Eric B. Larson, MD, MPH, Kaiser Permanente Washington Health Research Institute (KPWHRI) executive director, and Kaiser Foundation Health Plan of Washington vice president for research and health care innovation

Into the national discussion on health care reform, a bipartisan committee of policy experts just dropped a new report: “Vital Directions for Health and Health Care: Priorities from a National Academy of Medicine Initiative.”

The JAMA report summarizes a year of work from a group of more than 150 top researchers and policymakers who wrote 19 detailed papers to inform the committee’s work. The publication last month provides guidance for improving U.S. health and health care.

Reviewing the report, I was glad to see that KPWHRI’s mission and work aligns with the main recommendations, which focus on promoting health and well-being, high-value care, and strong science and technology. The report recognizes how the high cost of U.S. health care creates a strain on our economy and on individuals. It rightly calls out the burdens that health disparities and chronic illnesses impose on families and communities. Social determinants and the empowerment of patients and communities are recognized as major influencers of health. Simply acknowledging these factors indicates progress. And I appreciated that the authors call for supporting research. That message is particularly important during national budget discussions.

Despite these positive features, however, the report’s ring of familiarity left me thinking, this is old news. Something more is needed.

Is the devil in the details — or in our culture?

My friend and colleague Don Berwick shared a similar response in an impassioned JAMA commentary accompanying the report’s release.

Don is the former acting administrator of the Centers for Medicare & Medicaid Services and is now back with the Institute for Healthcare Improvement. He praised the report as offering “a template for change broad and inclusive enough for it to be a charter for coherent and effective system redesign.” But he questioned whether our nation has the collective will to promote the vision the report proposes. The devil is not in details, he wrote. “The devil is in the culture.”

Will our nation commit to the report’s recommendations? It’s an important question for policymakers and leaders nationwide. Looking within our own organization, I see a nearly perfect match between the report and our work at KPWHRI and Kaiser Permanente nationally. Just consider the four Kaiser Permanente beliefs stated by CEO Bernard Tyson:

• We believe that life, liberty, and the pursuit of happiness require total health — and that includes equal access to high-quality health care for all;
• We believe that total health is more than freedom from physical affliction — it’s about mind, body and spirit;
• We believe that health care must be affordable for all — because thriving individuals, families and communities require that;
• We believe in a healthy and engaged life — with good beginnings and dignified endings.

These examples of work underway at KPWHRI also support the goals described in the Vital Directions report:

• A component of high-value care is cost transparency. This is a sensitive, complex topic, but KPWHRI’s Dr. Nora Henrikson is on the forefront of the movement to provide this information to patients receiving oncology care.
• Ongoing work of the KPWHRI Center for Health and Evaluation (CCHE) addresses social determinants of health. Among other projects, CCHE is involved in a $90 million national project to help communities become more healthy, equitable, and resilient to climate change.

• The strong science and technology recommendations note the potential of tools such as electronic health records to create learning health systems. In this aspirational journey, research influences practice and issues important to providers and patients drive our research. Our members have accessed their electronic health records since the early 2000s. In addition, we’re working on the best ways to apply modern genomic information to an individual’s health and health care, especially in the frontiers of science like integrating genomic results into care.

Our work and our passion

The Vital Directions report provides an action plan to improve care in the United States. But perhaps the most important message is this: Let’s start talking less and doing more. We’ve known for decades what our health priorities should be. Here at KPWHRI, our job has always been to find practical ways to move us to our destination: affordable, high-quality health care guided by evidence from research conducted in a high-functioning Kaiser Permanente delivery system. That’s our work and our passion.

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