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The Latest News from the World of Public Health Profiles by Mike Field
Gerard Anderson To understand why Health Policy and Management Professor Gerard Anderson was recently voted one of the 100 “most powerful people in healthcare” by the readers of Modern Healthcare magazine, one need only ask him what may have drawn their attention. “Well, I do a number of things, so I’m known to a number of different audiences,” comes his reply. He then reels off a half-dozen current and ongoing academic interests: Medicare payment reform; a delivery system that is more responsive to those with chronic illnesses; comparative analyses of differing national health systems and outcomes; medical education; hospital payment reform; technology development and assessment; and health care cost analysis. It is no wonder that, as the Modern Healthcare article points out, Anderson serves on multiple editorial committees, has written two books and 140 journal articles, and has been called to testify before Congress on various health care issues more than 25 times. Anderson, PhD, knows the American health care system intimately. Prior to joining the Hopkins faculty in 1984, he held various posts in the Office of the Secretary of the U.S. Department of Health and Human Services. There he helped devise a plan to change how Medicare reimburses hospitals for care—a plan that standardized what had been a wildly uneven system. The approach was subsequently adopted by about 50 other countries around the world.
During his time in government, Anderson became especially intrigued by what Americans spend on health care and what they get in return. Those numbers indicate to him the system is in serious need of reform. We are, he says, entirely unprepared for the third era of modern medicine. “From about 1900 to 1950 was the era of infectious disease, and we got really good at finding solutions for things like polio,” he says. “The next 50 years we got good at heart attacks and other acute episodes. But now people are living longer, the population is getting older, and we’ve entered the era of chronic diseases. But the system is [still] focused on acute illness. We are entirely unprepared for this new reality.” Anderson notes that about half of all Americans suffer from at least one chronic disease, such as hypertension, asthma, or diabetes. About one in five has multiple chronic conditions, and 5 percent have four or more conditions. This smallest group is of particular concern as they account for a quarter of all U.S. health care spending and fully 80 percent of the costs of Medicare. Managing these cases—and their costs—is the great unmet health care system challenge of the 21st century, says Anderson.
It is the last requirement that Anderson believes will be the biggest obstacle to overcome. “The hard part in all this is convincing doctors that this is important to do, and even worth changing how they do things now. The system can be changed, but not overnight. It’s a 10- to 20-year proposition.” |
His Rx? Currently, patients with multiple chronic illnesses typically see multiple doctors and receive multiple medications. Yet no one doctor is assigned to review and coordinate this care. “First, we have to start paying one of those doctors for care coordination. Second, we have to create and deploy a standardized computer information system to make care coordination possible. Finally, we gotta convince the doctors that this is worth their time.”