Transformation of the Health Care System
One participant recalled writings by Atul Gawande on health care reform and the compelling arguments he has given about the changes that have to occur in the system, such as focusing on the highest consumers of health care, the unnecessary variations in care patterns, and the need to follow evidence-based best practices. Arora responded that he (and his colleagues) have a CMMI grant to develop a new specialty in medicine—the outpatient intensive care team—to target the 5 percent of Medicaid patients who consume 57 percent of the resources with the support of ECHO-like knowledge networks. Arora added that reducing variation was not an explicit goal of Project ECHO, but noted that when best practices are used and decisions are discussed in a forum of peers, variation automatically reduces. Tracy pointed out that variation can also be due to institutional politics, noting that unless ICUs are closed (with an intensivist in the lead), the multiple providers may not be willing to consult with each other in decision making. Appelgate responded that population health care managers need strategies to adapt projects to any location.