Gov. Berwick? Massachusetts Could Be Lab For Former CMS Chief’s Health Policies

If Berwick moves ahead and is successful in a campaign to succeed Gov. Deval Patrick, he could have an influential platform for his ideas on reducing health care system costs while improving quality.

Former CMS Administrator Donald Berwick is considering a bid for governor of Massachusetts at a time when the state is grappling with surging health care costs resulting from its move to near-universal insurance coverage in 2006.

If Berwick decides to run and is successful in a campaign to succeed Gov. Deval Patrick, D, whose term ends in January 2015, he would find an influential platform for his ideas on reducing health care system costs while improving quality. Berwick announced he is considering a run for governor on his recently launched website, berwickforgovernor.com.

A Democrat, Berwick carries with him a close association with the Obama administration and the Affordable Care Act because of his 17-month stint as CMS administrator during the law’s passage and early days of implementation in 2010 and 2011. He left CMS in December 2011, when it became clear that opposition from Republicans in Congress would prevent his continuing in the role (Also see "CMS Administrator-Nominee Tavenner Would Bring Leadership Continuity As ACA Implementation Continues" - Pink Sheet, 23 Nov, 2011.).

Other Democrats who are considered possible candidates for the governorship include state Treasurer Steven Grossman and state Congressman Michael Capuano (D-Somerville). Former U.S. Sen. Scott Brown may enter the race on the Republican side.

Berwick has not held elected office before and is not widely known outside of health care circles. He was CEO of the Institute for Healthcare Improvement prior to joining CMS. He returned to his home base in Massachusetts after he left the agency. Berwick is also a senior fellow at the Center for American Progress.

On his new website Berwick announced: “I’ve been proud to call Massachusetts home for decades – as a student, a pediatrician, a teacher, a CEO, and a father and grandfather. Now I’m giving serious consideration to a run for governor.” He added that “during the next few months, I’ll be traveling around the commonwealth to hear from as many of you as possible about your concerns, hopes, and expectations of our next governor.”

Former Boston College political science professor John Tierney, a longtime friend of Berwick’s, is acting as treasurer and chairman of Berwick's exploratory campaign. Merck Chief Medical Information and Innovation Officer Sachin Jain is also advising Berwick on his campaign on a volunteer basis. Based in Boston, Jain is a former student of Berwick's at Harvard and is also a long-time friend, according to Brian Chiglinsky, who is helping the campaign as a press liaison. Jain spoke on the topic of medication adherence at recent conference (Also see "Medication Adherence Is A Multifaceted Problem Requiring A Multifaceted Solution, Merck Exec Says" - Pink Sheet, 25 Mar, 2013.). Chiglinsky previously worked in public affairs at CMS.

Health care developments in Massachusetts have been closely watched by stakeholders both inside and outside the state because it has been a trailblazer in health care reform – the Affordable Care Act was modeled on the state’s coverage expansion legislation. Lawmakers in Massachusetts have since turned to controlling health care cost growth. As part of that effort, the legislature passed a law in 2012 establishing that health care spending cannot increase faster than the state economy (Also see "Massachusetts Bill Directs “Feasibility” Study Of State-Negotiated Drug Pricing" - Pink Sheet, 1 Aug, 2012.).The spending cap is set at 3.6% in 2013, considered to be a significant challenge for health care providers.

The prospect of Berwick developing influential cost control policies as governor of Massachusetts is likely to prompt concerns among some observers. While in Washington, Berwick repeatedly asserted his dedication to a patient-centered focus on improving health care quality while reducing spending. Nevertheless, congressional Republicans continued to characterize his philosophy as tending toward health care rationing as a means of controlling costs.

Berwick And NHS

Berwick’s association with the U.K.’s National Health Service has also contributed to concerns that his policies are aligned with rationing. He acted as an advisor to the U.K. government on improving the NHS during the 1990s, which led to his appointment by Queen Elizabeth as an Honorary Knight Commander of the Order of the British Empire.

Berwick’s latest involvement with the NHS appears focused on correcting a situation in which an emphasis on cost savings has led to serious patient harm. In early February, U.K. Prime Minister David Cameron announced that Berwick will lead an advisory panel tasked with ensuring that NHS budgetary concerns do not lead to practices that endanger patients. Cameron authorized the initiative in response to reports linking numerous deaths with substandard care in hospitals controlled by the Mid Staffordshire NHS Foundation Trust between 2005 and 2009.

“I have asked Don Berwick – who has advised President Obama on this issue – to make zero harm a reality in our NHS,” Cameron said.

Cameron also announced that a public investigation into accusations of negligence and abuses concluded one “fundamental problem” with the NHS is “a focus on finance and figures at the expense of patient care.” he added “this was underpinned by a preoccupation with a narrow set of top-down targets pursued to the exclusion of patient safety or listening to what patients, relatives – and indeed many staff – were saying.”

Berwick has described his role in the NHS project as a one-time commitment and says he is focused on testing the political waters in Massachusetts.

He may find state politics easier to navigate than what he faced as part of the Obama administration. On his website, Berwick notes “in Washington, I saw first-hand both the best and the worst of government. I was deeply troubled by the partisan paralysis in D.C., but also inspired by what good policy and sound leadership can do. Massachusetts is a different story – a better one. We aren’t paralyzed. We’re pace-setters.”