Opportunities, from Alice Gosfield

Jan 15, 2008, 12:00 AM, Posted by

Alice Gosfield, Esq.’s entire 34-year legal career has focused on health law. Ms. Gosfield served as Chairman of the Board of Directors of the National Committee for Quality Assurance and was President of the American Health Lawyers Association. She is currently Chairman of the Board of PROMETHEUS Payment, Inc., a not-for-profit national multi-stakeholder project to develop a new provider payment model. (In the spirit of transparency, RWJF’s Quality/Equality team has made a planning grant to test the PROMETHEUS model.) Gosfield told Pioneer:

It occurs to me that there are five types of issues, some of which are quite different from the types of things you have funded and which may fall into the breakthrough category:

  1. Getting Guns off the Streets. If heroin, crack and meth addiction are a public health problem so is getting guns of the street. Using entertainment, video and completely different forms of communication to get guns out of communities and gunshot wounds out of the nation’s ERs seems an important issue that health care foundations are not addressing. There has to be a way of thwarting the desire to have the guns in the first place rather than controlling the selling of the guns...We are spending scarce resources in our health care delivery system on something that shouldn’t even exist as a problem.
  2. Community Created Health Resources.For many years, the view of the emergency department as a source for care for non-emergencies has been decried as a waste of money and resources. Urgi-centers, whether owned by hospitals to lower the pressure on ERs, or as feeders for their physicians and services, have never generated much in solution. The advent of Redi-clinics and Minute Clinics speaks to the need to get convenient care to where people are. Why isn’t there a Habitat for Humanity for health care resources so that people in a community who work to design and build their local health care resource could develop a real stake in the ongoing process of receiving care much the way building a home creates a connection with maintaining it?
  3. Resolving the Tension between Standardization and Innovation. How can we increase quality and expand access—where economies of scale actually arise in a capitalist structure—if we are focused on standardized medicine and centers of excellence? The tension between increased standardization to science for quality, and both innovation in clinical delivery processes as well as diffusion of resources to meet access and convenience issues, has not yet been addressed with breakthrough solutions.
  4. A Fresh At Look Health Care Payment Systems. Today the poles in the health care payment world are defined as a government- sponsored universal health system or consumer driven health care, which often is code for high deductible, tiered health care network employee based insurance. There has got to be more creativity available on this. Everything I read is from the same guys from the same orthodoxies writing in the same journals complaining about the same stuff but not creating or proposing anything really new. More focus on payment mechanisms that engage customers of health care in their own care delivery without merely requiring them to be responsible for co-pays would give them a stake in the game. It would also advance us well beyond what the last 50 years of employer sponsored health insurance has created.
  5. Regulatory Systems That Protect People and Foster Innovation.Patient safety is not adequately addressed in current regulatory mechanisms. The many ways in which licensure regulation impedes real quality is insufficiently known and some real breakthrough thinking would be interesting and would have impact on other issues including access, payment and consumer-engagement.

This commentary originally appeared on the RWJF Pioneering Ideas blog.