Remarks to the Remarks to the National Association of National Association of State Veterans HomesState Veterans Homes

March 1, 2010March 1, 2010

Phillip LongmanPhillip LongmanSenior FellowSenior Fellow

New America FoundationNew America Foundation1899 L Street, N.W.1899 L Street, N.W.

Washington, D.C., 20036Washington, D.C., 20036(202) 986-2700(202) 986-2700

Longman@NewAmerica.netLongman@NewAmerica.net

Assignment: Who is the Assignment: Who is the Jack Welch of Health Care?Jack Welch of Health Care?

General Electric CEO and “Manager of the Century” according Fortune magazine.

“The U.S. News & World Report list began in 1990 and Georgetown has claimed top honors since its inception for 11 consecutive years.”

Georgetown University Hospital Press Release,

2001.

Utilization Rates During the Last Six Months of Life Among Patients with At Least One of Nine Chronic Conditions Receiving Most of Their Inpatient Care from Selected Academic Medical Centers (Deaths Occurring 2001–05)

Dartmouth Atlas of Health Care, 2008

Where’s the Science?

000-50-5000

000-50-5000

The VA: Conceived in Scandal

“Colonel” Charles R. Forbes, 1924

World War I deserter, embezzler, imposter, and first director of the Veterans Bureau.

Warren G. Harding

Tom Cruise’s depiction of life in a Bronx VA Hospital, 1989

Sample dialogue: This place is a f***ing slum!

Articles About VA’s Articles About VA’s QualityQuality

“ “ . . . Overall, VHA . . . Overall, VHA patients receive better patients receive better care than patients in care than patients in other settings” other settings”

What is Quality in Health What is Quality in Health Care?Care?

The More Things Change…The More Things Change…

[Not until some-where around 1911 was it true that] “a random patient with a random disease consulting a physician at random stood better than a 50-50 chance of benefiting from the encounter.” Professor L.J.

Henderson (1879-1942)

Harvard University

1911 2004

The History of the Hard The History of the Hard HatsHats

DeviantDeviant SecretiveSecretive InsubordinateInsubordinate PersecutedPersecuted PerseveringPersevering TriumphantTriumphant UnsungUnsung

“There is no reason for any person to have a computer in their home”

~Ken Olson, President, Digital Equipment Corporation, at the Convention of the World Future Society, 1977.

Wally Fort

George Timson - 1980

“Hard Hat” Greg Kreis

A Two-User Wang 3300 System, circa 1970

The Origins of VistA

To overcome a Central Office ban on personal computers, “Hard Hats” ordered and then modified word processors designed for secretaries.

Out of the Garage

Dr. Kenneth Kizer, accepting 2006 "Leadership in Innovation" award for “the transformational work accomplished while he was at the helm of the Veterans Health System”

Dr. Kenneth Kizer, Dr. Kenneth Kizer, Change AgentChange Agent

Third year student Bjorn Engstrom with patient at the TheVeterans Affairs Medical Center in White River Junction, Vermont.

Take Home Lessons

•The VA’s long-term relationship with its patients provides incentives lacking elsewhere in the health care system for investment in prevention, effective disease management, and other metrics of quality.

• The VA’s collaborative “open source” culture points the way for getting medical professional “buy in” for health IT and its integration into medical practice.

• The VA’s use of its digitalized records to perform population-level outcomes research illustrates how true, “evidence-based medicine” depends on a large and integrated IT infrastructure.

• The VA’s quality revolution shows that when it comes to health care, more market competition isn’t necessarily the answer. The VA’s structural liabilities as a government bureaucracy are more than overcome by its ability to integrate care and perform as a true, scientifically-managed system.

Phillip LongmanSenior FellowNew America Foundation1630 Connecticut Ave., N.W.Washington, D.C., 20009(202) 986-2700Longman@NewAmerica.net