Improving Health and Health Care

Private foundations like the Robert Wood Johnson Foundation are like venture capitalists for ideas. Today, I'm going to talk about our priorities and strategies for improving the health care system and health care. I will reflect on the challenges we face in implementing our agenda, outline strategic directions, and suggest how engineering and medicine can be linked.

I want to make three points. First, I believe the major problem in health care is not a lack of tools, although we have heard about new tools that could and probably should be developed. The major problem is the way we use existing tools. Second, in thinking about using engineering principles, theory, and knowledge, we must think about health, not just health care. We must think beyond the health care delivery system to using technology to actually improve the health of people. We must think beyond the organization and financing of our current health care system. Third, bringing engineering and medicine together is not predominantly a technical problem; it is a cultural problem.

The Robert Wood Johnson Foundation is one of the largest foundations in the country and the largest foundation devoted to improving health and health care for Americans. We have about $8 billion in assets and award $400 million annually in grants. We use a variety of methods to achieve our goals—such as supporting research projects, demonstrations, training, communications, and workshops. Our work is organized around three goals: (1) ensuring that all Americans have access to care; (2) improving care for people with chronic health conditions; and (3) helping the country deal with substance abuse. General improvement is part of our mission, but the specifics are embodied in our goals. We encourage the health care system to do the right things. In some cases, we support innovations. In addition, we promote the diffusion and adoption of existing best practices.

For example, a program called Improving Chronic Illness Care run by the Group Health Cooperative of Puget Sound focuses on improving care for people with chronic illnesses. Our health care delivery system generally focuses on acute care; the system is geared toward treating infectious diseases and acute traumas. There is a mismatch, however, between that model and the prevalence of disease, predominantly chronic illnesses that require a different model of care with different elements.

A chronic care model of health care delivery includes linkages between the health system and the community, as well as support for self-care and self-management. A health care delivery system organized for chronic care must provide decision-support tools for providers and for patients and families. It must also have a supporting information infrastructure; in addition, the health care delivery team must be redesigned and retrained. The foundation has provided $32 million to support projects, research, and demonstrations and provide technical assistance to promote a health care system configured to treat chronic illnesses.

Read more on https://www.ncbi.nlm.nih.gov/books/NBK22855/