Background for “Making Health Reform Work”

In 2003 I was invited to address the Presidents of the State Medical Societies on the topic “The Future of the US Healthcare System” at their June meeting in Chicago. This presentation occurred 6 months before Congress passed the landmark Medicare Modernization Act, and at that time the fate of the legislation – along with the future of Medicare and other major health initiatives – were very uncertain.

To help these physician leaders see the future more clearly through these murky waters, I discussed the quantitative and qualitative trajectories of the major US healthcare programs – including Medicare and employment based insurance – and policy initiatives that cut across public and private systems and payers, such as transparency and accountability.  I then described a future where healthcare providers and clinicians would be responsible for demonstrating the clinical and economic outcomes their care was delivering, how payments would be tied to these outcomes, and how doing this would be facilitated by electronic medical records and population-based analytical systems.

This presentation was in many ways a nexus for the work I’d been doing for 15 years, and it led me to start writing a book that started with the working title of “Fixing the US Healthcare System.” However, the 2008 campaign, election of President Obama, and the subsequent enactment of the Affordable Care Act, (a.k.a. Accountable Care Act), presented fundamental shifts for the US healthcare system, leading me to change the title to “Making Health Reform Work.”

While revising the content of the book to reflect the rapidly changing landscape – and putting snapshots of the draft book’s ideas and concepts into blog postings – I began working with a leadership group in a Midwestern community to align the vision and efforts of stakeholders and diverse organizations across the community to improve the quality and efficiency of their healthcare. This work was an exciting opportunity for implementing many of the alignment and cultural transformation concepts I’d been writing and revising in texts, tables, and diagrams in the draft book.

To see a working summary of the book click “Making Health Reform Work”.