I have been thinking back about what ideas, at the 30,000 foot level, have occurred in health care in the last 2 decades.  What has changed that is making a difference or will in the near future.   And, however you feel about CMS, watching what they focus on helps clarify where things are going.  The big ideas that come to mind:

Quality and Safety – From my days as a student nurse, safety was drummed into my head.  So I was as surprised as everyone else then the IOM “To Err is Human” report came out in 1999. This was a real shock to the US Health Care System.  And sadly, we still aren’t doing very well, but at least we are paying attending.  And CMS Innovation Center is insisting “rapid cycle improvement” strategies, a foundation process for quality and safety, be included in all funded work.

Health IT – Probably the best health care innovation to come out of the Bush 2 administration was the focus on health IT.  Like quality and safety, we aren’t there yet, it is still more about billing than quality, but you can see the trends.  One of the coolest IOM reports I saw recently was the work on establishing a criteria and data elements for including social and environmental data in electronic health records.  And Health IT, for those of you who aren’t putting this together with Quality and Safety…is foundational to monitoring and affecting quality and safety.  Again, CMS is requiring that all projects address how health IT is optimized in the project.

The Affordable Care Act – I remember when President Clinton got elected and the American Nurses Association went wild with the concept of “health care as a basic human right”.  Well, we are over 20 years later and we aren’t there yet, but the ACA is based on this unstated assumption and eventually it will become the norm; much like Medicare did several generations ago.  No need to comment on CMS here!

Value-based Reimbursement – This is happening for many health care providers even as I write.  It is early days yet, but the critical point is that we are being pulled from a productivity model of health care delivery back into (we were there once) a service model.  In other words, we will be judged on the quality of the service (cost effective, satisfied customers and good outcomes) as opposed to the days of counting widgets.  Another change in health care driven by CMS.

So instead of looking at the challenges and the bureaucratic complexity of these changes in health care, take a few minutes to reflect on  the amazing positive sea changes that are happening.  This huge ship we call the US Health Care System is slowing changing direction in two critical ways; our society is beginning to recognize  health care as a basic human right  and we are slowing moving from a productivity model (numbers) to a service model (quality/value).    Good News! and Happy New Year!