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Donald Berwick: The Good Doctor at CMS

Jim Molpus, for HealthLeaders Media, December 2, 2010

In our annual HealthLeaders 20, we profile individuals who are changing healthcare for the better. Some are longtime industry fixtures; others would clearly be considered outsiders. Some are revered; others would not win many popularity contests. All of them are playing a crucial role in making the healthcare industry better. This is Donald Berwick's story.

So much about leadership is timing. Donald Berwick's timing for leading the Centers for Medicare & Medicaid Services may be the perfect man for his times, or just the opposite, depending on who you ask.

Medicare alone now covers 47 million Americans and accounts for 12% of all federal spending. Some 48 million Americans are signed up for Medicaid, a number that will grow by an estimated 15 million under the provisions of the Patient Protection and Affordable Care Act. The CMS that Berwick inherited was already a massive, influential, but largely stagnant bureaucracy. Berwick's goal is to transform CMS from a bureaucracy into something more like a revolutionary force. He intends on using the reach and power of the federal government to herd elements of a fractured industry  in hopes of closing gaps in waste that costs taxpayers dollars and threaten patient care, all while overseeing the most massive expansion of government coverage since the Johnson administration.

Berwick's record as a healthcare shepherd is unassailable. Through the Institute for Healthcare Improvement he founded, Berwick and his team cleverly hooked into the healthcare industry's untapped desire to improve with catchy, actionable programs like the 100,000 Lives Campaign. His critics worry that at CMS, what Berwick envisions would be less like feel-good voluntary programs and more toward British-style universal care of which he has spoken fondly. It was that part of his background that conservatives rang loudly as his nomination was announced. His confirmation never came, and Berwick was installed through the political backdoor of a recess appointment that expires next year.

Even in the space of a few months, Berwick has launched the Center for Medicare and Medicaid Innovation, and has pushed the first steps for the creation of accountable care organizations. During that same time Berwick has been largely withdrawn from the public spotlight, declining interview requests and letting speeches at carefully chosen industry events reveal his plans one layer at a time. Still, many in the industry's leadership hold out hope that Berwick can use his strengths to shape CMS in ways that his predecessors have not even attempted.

"Dr. Berwick's biggest strength is that he understands the current delivery system is broken and, therefore, we need to reform the delivery system as well as access to insurance in order to improve the quality, patient safety, and inefficiencies," says Dan Wolterman, CEO of Houston-based Memorial Hermann.

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