At a recent meeting about implementing the Accountable Affordable Care Act, Don Berwick, (the recent CMS Administrator, and the Founder and former CEO of the IHI), listed 7 areas that worry him about continuing with successful health reform and the implementation of the ACA. (Note – I’ve rephrased some of these into question form and added some summary comments.)

1. Will Care Change? (After payments change to incentive value rather than volume.)
   
2. Will Costs Actually Be Reduced? (It is too early for much data, but can we get to a sustainable level of GDP spending on healthcare, e.g. 15%?)
   
3. Will the Mechanics of Coverage Be Successful? (e.g. Insurance Exchanges)
4. Will the Safety Net Be Maintained/Sustained? (i.e. Beyond Medicaid)
5. Will there be a Continued Commitment to Science? (People want healthcare that works, e.g. evidence based medicine.)
6. Will Prevention Efforts Continue? (It is easy to say, hard to do, but also an easy target for funding cuts.)
7. Will Communications to the Public About the Value of Healthcare Changes Improve? (Debra Ness, the President of the National Partnership for Women and Families, noted in a later panel that “normal” people – i.e. non-healthcare wonks – don’t understand the terminology that “experts” use, but when they describe what they want from the healthcare system, it sounds very much like the basic elements of a patient-centered medical homes. This indicates that the public should like the system we are moving towards, but they don’t understand the vision because the communications hasn’t been appropriate…. Something I wrote about last year. )

Two other important facets of healthcare improvement that he noted later in his remarks are:

1. States are moving forward as experimental fountains – and this is a good thing.
2. There is a great need for engaging the business community as major payers – their voices have not been involved enough in local and regional discussions.

These are all important aspects of implementing healthcare reform where the decisions made by local, regional, and national entities could either accelerate or stall progress towards higher quality, lower costs, and better care experiences.  As such, they are now part of my list for determining if initiatives will likely be successful, or may be moving in a direction that won’t produce the desired results, e.g. by reinforcing or expanding local monopoly-like entities.

P.S.
Later in the conference Dr. Berwick noted that in his discussions with the leaders of healthcare organizations around the country they are consistently facing the “How” challenge.  That is, they all recognize that the healthcare world is rapidly evolving and although the payment system hasn’t yet changed significantly, they know it will, and therefore they are seeking to understand how to transform/restructure their delivery operations and supporting infrastructure, (e.g. IT systems), to be ready for this future that is rushing towards them.