We want it all when it comes to health care: patient satisfaction, provider satisfaction, better health outcomes, and lower costs. 

With recent policy changes at the state (Sustinet) and national level (health care reform and SCHIP reauthorization), we are in a historically advantageous position to achieve these four wins.  Yet, despite the push for innovation at state and local levels, despite new options for financing, and despite the political will driven by the uneasiness as to what a status quo health care system could mean for everyone's economic and physical health, achieving a win-win-win-win remains extremely daunting.

I am very honored to represent United Way of Greater New Haven on the Patient-Centered Medical Home committee, that is charged with reporting to the Sustinet Health Partnership Board on the effective implementation of patient-centered coordinated care for residents of CT.    My peers include providers, public and private insurers, and advocates; and we are informed in our efforts by leaders in the field from across the nation. 

On May 19, we heard from Ron Preston -- former Secretary of Health and Human Services in Massachusetts and former Health Care Financing Administration Region I (New England) Associate Regional Administrator: in short, a substantive, experienced leader in moving state and federal systems in support of health care reforms.  I learned more than I could possibly absorb about potential Medicare waiver opportunities that could be the pivotal piece to change the financing of health care in support of better delivery methods (e.g. Patient Centered Medical Homes).  In essence, if all the other players (Medicaid and state public and private insurers) are on board, there is now the potential for Medicare to come to the table with all of its weight (big dollars) and play too...they are the weight at the end of the sled we need to move down this hill. 

All of the back-end mechanics aside, what this could mean is a slow wave transforming the delivery of health care to a patient-friendly and patient-centered system where care among all types of providers is coordinated, easier to access and understand, and achieving healthier results.  That's for all of us.  If done right, it should improve provider satisfaction too, and hopefully have the result of making careers in primary medicine more appealing and lucrative.  I like it.

But Ron is a pragmatist.  He waved a warning flag about the fourth win of health care that is needed: saving money.  The research tells us that Patient Centered Medical Homes, and similar forward-looking strategies for changing the delivery of health care, can get us to the first three wins.  The unknown is how to change the cost curve.  He referenced a 2003 study in Health Affairs by Princeton's Uwe Reinhardt that notes that it is unclear if any of these new ways of doing business will have the desired affect on costs.  But his final comments were the mix of pragmatism and optimism that is needed to get through these prolonged challenges: "medical homes are not sufficient to change the cost curve, but they are necessary to get us there."  That's a motto I can adopt to stay -- practically and optimistically -- in this game.

Learn more about Sustinet at http://www.ct.gov/sustinet/

Learn more about the Universal Health Care Foundation at http://www.healthcare4every1.org

Learn more about United Way Worldwide's work in Health at http://liveunited.org/health/