Cut, withhold or improve?

This week brings the opportunity to speak with members of US Congress to discuss the importance of public hospital and health systems and California's Medicaid program — known as Medi-Cal — which provides health insurance and long-term care coverage to low-income children, their parents, elderly, and disabled people in our state. Medi-Cal is the cornerstone of our health care delivery system and supports critically needed care for over 7 million Californians.

Cuts to Medicaid, whether in the form of caps, or other across the board limits, translate into a potential dramatic reduction in core services for low-income and vulnerable Medi-Cal patients. This is a particularly complex issue as cuts of this nature not only undermine public hospital and health systems ability to care for our community, but challenge coverage expansion efforts under health reform.

This week I will urge members of Congress to resist significant cuts to Medicaid as a strategy. While cutting services and staff, or withholding benefits may seem like an easy way to reduce costs, there is another way: remove defects, duplication, inefficiencies and rework from our health care systems; provide the care that people want and need; produce health.

I applaud The Centers for Medicare & Medicaid Services (CMS) for their leadership in supporting pursuit of continuous improvement and innovation through the 1115 Waiver and Delivery System Reform Incentive Payments Program (DSRIP) in California and most recently in Massachusetts. In contrast to cutting service as a cost containment strategy, improvement, isn't easy: it takes time, it can be difficult to identify which specific changes led to improvement and it requires skill and discipline in improvement methods.

“We can't solve problems by using the same kind of

thinking we used when we created them.” ~Albert Einstein

We are at a critical crossroads. We stand at the threshold of a new era with the real possibility of a reformed health system, but it will take local and national leadership and supporting policy. We can pursue the historically unsuccessful and unsustainable approaches to cost containment we have typically applied in health care, or we can become better. We can cut service in our country, increasing human suffering and despair, or we can improve our health systems and provide the care our communities want, need and deserve.

I am proud of our system and our partners commitment to continuous improvement. I will be following closely the efforts of this weeks upcoming Rapid Improvement Event (Kaizen). I look forward to hearing about the work at this weeks report out and hope you can join me.

More very soon.
Anna