Berwick: Connecticut can be a prototype in health system changes

Connecticut can be a prototype for the country in implementing federal health reform and transforming the health care system, a key Obama administration official said during a visit to the state Monday.

Dr. Donald M. Berwick, administrator of the Centers for Medicare and Medicaid Services, said the state can do so by “getting everyone around the table.” And after meeting with hospital officials, physicians and state leaders Monday, he said he was pleased that “everyone seems in it together here.”

“It may sound romantic, but I really like what I heard,” he said.

Berwick, a Moodus native who has been controversial in Washington, runs an agency charged with overseeing programs that provide health care coverage to nearly one in three Americans.

His job puts him in a key role to shape health system changes, although how long he’ll keep it is not clear. President Obama gave Berwick a “recess appointment,” avoiding a Senate confirmation fight. Conservatives have raised concerns about Berwick’s emphasis on reducing health care costs and have accused Berwick of favoring health care rationing, while liberals have praised him and said Republicans have distorted his record.

In Connecticut, Berwick, who spent the day with Rep. John B. Larson, found a state where health reform has caused relatively little controversy. Gov. Dannel P. Malloy, who addressed reporters with Berwick, has said he is committed to implementing federal health reform, and administration officials are moving forward with plans to develop the health insurance exchange, the marketplace for purchasing health insurance that will play a central role in expanding coverage in 2014. In many ways, federal health reform has been overshadowed here by a fight over whether to create a state-run health insurance plan, called SustiNet, that would be sold to the public.

“We actually firmly believe that Connecticut, as I’ve said many times, can play a leading role in developing this new system in the United States,” Malloy said Monday. “We are availing ourselves of every dollar that we can go after to make sure that we are putting that system into place, including the technology necessary to be compliant.”

Berwick said Connecticut is “on track” in implementing health reform.

“Here in Connecticut, there seems to be a very firm commitment to implementing the Affordable Care Act at the best possible level for your citizens and for the state as a whole,” Berwick said. “I think you can be a prototype for the country, and I’m very excited by what I’m hearing.”

Asked what unique challenges Connecticut faces, Berwick, whose father was a general practitioner in Moodus, said the distribution of physicians into smaller practices could be “a little bit of a challenge.”

But he added, “I think Connecticut has many, many opportunities here. It has the resources, the intelligence, the academic organizations, and a really good infrastructure, hospitals and institutions, so I think it’s well positioned to show the country what health care can really be like.”

Berwick has been visiting states across the country, and said he has been struck by the readiness of people to make changes. He said the attitude he found among health care leaders in Connecticut, as in other places, was “It’s time, how can we help?”

“Everybody seems right now to understand that the time has come for us to move toward the system that we want, better for the patients, oriented toward providing health and at a cost that can be sustained,” he said.

Berwick also took a swipe at a Republican proposal to replace the existing Medicaid system with block grants, giving states a fixed amount of money to use to provide coverage, and to revamp Medicare by providing seniors with federal funding to buy health insurance.

Better care costs less, Berwick said, and the way to lower costs and to strengthen Medicare, Medicaid and the insurance system is to provide better care, Berwick said.

“The other way that’s being proposed right now in Washington is just to cut care, to withdraw benefits, to shift cost to Medicare, Medicaid beneficiaries, to really end Medicaid as we know it and to really seriously damage Medicare,” he said. “All of that’s about cutting, and that’s a terrible way to do this. It’s the wrong way to do it. The right way is through improvement, and that would require the kind of work at the state level and in the communities here to make care better.”