Getting Health Care Right

grand junction colorado skyline

Grand Junction, Colo., a cost-quality leader. Eleaf/Flickr hide caption

itoggle caption Eleaf/Flickr

Let's call them the Four Horsemen of Health Care Improvement:

Atul Gawande, the surgeon and embarrassingly talented journalist; Donald Berwick, an indefatigable campaigner for better health quality; Elliott Fisher, a bigwig with the indispensable Dartmouth Atlas; and, Mark McClellan, the doctor-economist who oversaw the addition of a drug benefit to Medicare.

Forget the naysayers who proclaim that it's impossible to remake our health system to deliver better care at a lower cost, these four doctors write in the New York Times. It's happening already.

In 74 places (hospital referral regions, for the wonks out there) around the country, per capita Medicare costs are low or declining and the quality of care is above average.

This weekend President Obama is heading to another health town hall in Grand Junction, Colorado, a standout Gawande wrote about in his influential New Yorker article on health spending in June.

What's their recipe for success? It varies. Some places feature large medical clinics with salaried docs, like the Mayo Clinic. Others have made good used of electronic data systems to coordinate and manage care. Doctors in Grand Junction, Gawande wrote in the New Yorker, agreed to meet regularly on quality improvement and five years ago, with a local HMO, created a computerized record system for sharing patient info in the area.

"In their own ways, each of these successful communities tells the same simple story: better, safer, lower-cost care is within reach," the doctors write. Drop the rhetoric and follow the leaders, they say. There's no "need to be trapped between charges that reforms will ration care and doing nothing about costs and coverage."

Gawande Bonus: Check out Gawande's conversation with Dave Davies on Fresh Air's in June.



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