Andrew Bazemore, MD
Director,
The Robert Graham Center
Washington, D.C.
What will be your first priority as you move into your new role as director of The Robert Graham Center?
Amidst team transition and turnover this summer, and designing and moving into a new space this fall, our first priority will be a stable transition and reestablishment of a strong team and culture. Our research agenda will continue to explore primary care opportunities and challenges in the Affordable Care Act. We'll turn increasing attention to informing stakeholders at the state and local level to increase the supply of and efficiency in workforce and infrastructure necessary to accommodate the expected increase in primary care demand.
What is the biggest healthcare challenge currently facing the nation?
In a word: fragmentation. From training to delivery to payment, fragmentation across the health system will continue to cause costs to soar, and quality and access to suffer. We continue to overwhelmingly direct our biomedical research enterprise towards basic science instead of effective delivery, individual diseases over multi-morbidity and organ-systems instead of whole persons living in a complex milieu of familial, social and environmental determinants of health... We pay for fragmented delivery of individual services for patients and not for coordination, information integration and population-based care.
How can the nation best improve the quality of care while simultaneously controlling costs?
Well, first of all, quality must be measured on a population scale, with metrics that capture overall health and not the intermediate outcomes of healthcare and process steps that mitigate single diseases. To move that dial requires a shift from fragmentation to integration, whether of health delivery systems, information systems capable of supporting robust population based healthcare, or primary healthcare and unnecessarily disjointed partners in public health and behavioral health.
It is encouraging to see federal agencies with missions specific to health working together towards the 'Integration of Public Health and Primary Care' as reported on by the Institute of Medicine on behalf of the Health Resources and Services Administration and Centers for Disease Control and Prevention... The patient centered medical home must continue to evolve towards a central role in community health, and as a leader in experiments to craft medical neighborhoods, such as the accountable care organization. Equally important will be educational models that integrate training into community-based service delivery sites and break down the professional silos that inhibit team-based care. And of course, payment that promotes such integration - whether bundled, blended, or capitated - must be added to or replace the fragmenting effects of fee for service. The Graham Center will remain very interested in the dimensions of and strategies to improve such integration.
Interviewed by Rene Letourneau, Editor.