Interview with Dr. Jack Lewin

NEHI Newsletter
October 1, 2010

Dr. Jack Lewin is the chief executive officer of the American College of Cardiology (ACC), a 35,000-member organization representing American cardiologists as well as a growing number of international members. Under Dr. Lewin’s leadership, ACC has advocated for expanding access to care for uninsured persons and reforming Medicare, Medicaid and the financing and delivery of quality health care. ACC, which is based in Washington, D.C., became a member of NEHI in July.

NEHI: What is the greatest challenge to successfully implementing health care reform?

Dr. Jack Lewin: There are a few different obstacles that we’ll have to overcome. Political partisanship is a huge problem to implementing health care reform. The fragmentation of the medical profession is another enormous concern. The American Medical Association remains a powerful brand and successful business entity, yet it only represents one out of eight practicing physicians. The various primary professional associations do not forge consensus on key issues and this weakens the voice of medicine. Doctors are unwilling to invest their time in the political process, which is understandable given how busy they are but it puts them in an awkward position. Interestingly, the two central parties in health care are doctors and patients; ironically, they are the weakest in the political spectrum. But the biggest overall challenge is figuring out how to bend the cost curve while we add so many new beneficiaries to coverage.

NEHI: What innovations is the American College of Cardiology working on to advance health care reform?

JL: ACC holds itself accountable to four areas of reform and we are currently working in all of these areas. The first area is improving quality and effectiveness. We’d like to see new science translated into guidelines, performance measures and appropriate use criteria so they can be turned into clinical decision support tools at the point of care. One way, for example, is measuring quality of care at the point of care with registries and giving direct feedback to physicians and hospitals on outcomes and how frequently evidence-based care is being used. We now have inpatient registries in 2,400 hospitals and 1,000 outpatient practices – 11 million patient records in constant process –routinely reporting back to all users on their performance.

Our others areas are: promoting professionalism and ethical, patient-centered care, including shared decision making; improving coordination of care between hospital and outpatient care, primary and specialty practices, and all transitions of care; and designing and promoting new payment reform models that migrate reimbursement from fee-for-service to payment models that incentivize quality improvement and efficiency.

NEHI: Where are the greatest opportunities to weed out waste – whether overuse, underuse or misuse – from the system?

JL: The areas we are working on are great opportunities to address waste, especially efforts to improve quality and efficacy, promoting patient-centered care and figuring out new payment models. This will eliminate a HUGE amount of waste and improve outcomes, while reducing unnecessary hospital admissions, tests and complications, while promoting prevention.

NEHI: What lessons can we learn from the use of evidence-based medicine in cardiology, given that cardiology already has a strong reputation for disseminating and using evidenced-based medicine?

JL: It’s true that cardiovascular medicine has more science, guidelines, performance measures and appropriate use criteria than any other specialty. The field has invested its own resources to lead the way in these areas and it is related to the reduction of morbidity in cardiology over the last 30 years. But that said, still 50 percent of the science in our clinical tools is “expert consensus,” rather than based on randomized controlled trials. We have learned clearly, and sometimes painfully, that we need evidence. We need comparative effectiveness research so we can convert expert consensus to well documented evidence.

NEHI: What one thing would you change in our health care system to improve medication adherence for patients?

JL: Implementing certain technologies and approaches to care could have an impact on improved medication adherence rates. Providing doctors with feedback through electronic prescription systems, shared decision making and coordinated care teams, and tracking patient progress in reaching clinical goals through registries are ways to indentify problems.

NEHI: How can patients become more engaged and active in their own care and outcomes? Do you have any confidence that prevention can actually reduce the costs of care?

JL: Prevention is not a panacea for high health care costs. Prevention is an investment to improve quality and length of life – and sometimes it is expensive. All too often patients need incentives for improving adherence, lifestyles and outcomes too. We can use education and example as incentives, but we also need to put fiscal encouragements in place, like reducing co-payments or insurance premiums. We need to find ways to put positive incentives into the marketplace.

NEHI: Any advice for CMS Administrator Dr. Don Berwick?

JL: I would ask him to read my responses to this interview and make me a member of his kitchen cabinet! Dr. Berwick is a much admired and long-standing friend.