Berwick to hospitals: Focus more on health, less on reimbursement

ORLANDO—Social determinants of health could be improving faster if hospital executives took a different approach to managing them, according to several keynote speeches and presentations at the Institute for Healthcare Improvement's 30th National Forum on Quality Improvement in Health Care this week.

During Dr. Don Berwick's annual closing keynote speech at the conference, the IHI president emeritus and former CMS administrator pointed to research that illustrates the stark disparities in life expectancy among people who live just miles apart in the same U.S. cities. He said it's the obligation of providers to address these stark inequalities. "The causes of (health inequity) are not ours to accept, they are ours to change," he said. "If you want to improve health, you have to reduce inequity."

In an interview at the conference, which drew about 5,500 attendees to Orlando, Berwick said that it's an excuse made by providers when they say they can't adequately address social determinants of health because there isn't a reimbursement model available.

"To medicalize the social determinants and say you have to give money to healthcare organizations so they can go out and assure housing, that doesn't feel right to me … Practice should change. We need to divert some of the resources from waste in healthcare to these social determinants," he said.

Berwick added that addressing social determinants should be the core mission for health systems already. "If healthcare organizations were set up to create health in the community, that is your job, and you can't say, 'not our job.' And if your model doesn't reflect that, let's come up with one that does."

Berwick laid out six areas providers should try to address: early childhood, education, the conditions of work, aging, the resilience of communities and fairness.

Also in an interview with Modern Healthcare at the forum, IHI CEO Dr. Derek Feeley said that addressing social inequities hasn't been a strong enough focus for the healthcare industry. "If we look back at the Crossing the Quality Chasm (2001) book, and the six dimensions of quality, equity is the one where we've made the least progress."

Feeley said IHI will continue to work on addressing social determinants through its Pursuing Equity initiative in which nine healthcare organizations are working on ways to address racism in their communities.

Another keynote speaker was Dr. Mona Hanna-Attisha, who grabbed national headlines in 2015 when her research exposed the lead poisoning of children in Flint, Mich., from the city's water system. Hanna-Attisha, who did the research at Hurley Medical Center, said she was stonewalled when she asked the public health department about how the contaminated water was affecting children. She said that although the water crisis was caused by political and social forces outside of her control, she remembered her Hippocratic oath to do no harm, and felt it was her duty to dive into Hurley's own data to find out the impact, go public with the findings and try to fix the situation.

"I want to be able to tell every mom and dad we are doing everything we can" to make sure their child is healthy, she said. She then called on physicians "to act for what is right, even when it's hard, even when it's scary."