Tough decisions are needed to improve America’s healthcare system

Robert Otto ValdezPhD, MHSA, has been appointed director of the Agency for Health Research and Quality (AHRQ) in February 2022. Previously, he held a number of government and academic positions, including stints at the federal Department of Health and Human Services and as Special Senior Advisor to the White House Initiative on Educational Excellence for Hispanic Americans. Towards the end of the first full quarter of his tenure, Valdez spoke with Medical economics to discuss the state of the US healthcare system and AHRQ’s role in finding solutions to current challenges. The interview was conducted via Zoom and the following transcript has been edited for length and clarity.

Medical Economics (ME): You have a long career in many aspects of health care policy, finance and practice, and joined AHRQ in February this year. What should doctors know about what the agency is doing?

Robert Otto Valdez: Well, the AHRQ was created with a mission to improve health care in the United States. Unfortunately, the vast majority of the public know very little about the AHRQ and its work. The vast majority of our work is based on health services, research, improving practice and monitoring the functioning of the health system, through a set of primary data systems and datasets that help decision-makers at the federal and state levels to make decisions that affect the regimes under which health care is practiced in individual states and local communities. All health care is local. And so it is extremely important for us to understand what is happening across the country. It is extremely difficult for people to really understand, what real knowledge do we have? What real evidence do we have to improve health care? And a lot of the work of AHRQ, and its contributions to other agencies within the department and in the field, is to look at all of these publications and studies and narrow them down to what we can actually generalize and have trust as evidence for practice. .

ME: Earlier this month, AHRQ participated in AcademyHealth’s annual research meeting. In a recent blog entry, you talked about the conference and the dissemination and implementation of the results, “to improve our tattered healthcare system.” What would you like to see improved in the healthcare system? What should be repaired?

Valdez: Oh, what doesn’t need fixing? The pandemic has truly exposed long-standing issues in our health care system: barriers to access, out-of-control prices and costs, unacceptable quality, widespread racial and ethnic disparities, and inequities in the distribution of resources across the country and locally. . Like I said, all health care is local. And there are great disparities and inequalities from region to region and even within states, from place to place. The costs are really out of control. Our national spending is projected to gobble up 1/5 of the entire economy by 2026. This means we have to give up many other things in our society that we deem important. We pit our health care against the education of our children when we spend our resources in this way. So we have to make very tough decisions about what we can do.

ME: How do all of these factors affect patients and clinicians?

Valdez: Access is extraordinarily uneven from region to region, place to place. And they reflect state political regimes that dictate how health care can be practiced and how services can be provided from state to state, even when you’re side by side. Safety and quality, as I said, are dangerously poor. The pandemic has only made matters worse, as in the past two years, any gains we have made in the previous five years in healthcare security or safety have been largely lost. . Central line infections, for example, which had been reduced by 32%, have increased by 28% over the past 2 1/2 years. So basically we’ve undone everything we’ve done in the past. And that’s understandable because many of the safety issues are the result of our overworked workforce. And the need for our organizations to regain a culture centered on safety and quality. We have also seen our investments in health care misdirected. We have created investments in IT services that have actually contributed to this overstretching of our workforce and therefore contributed to the burnout that we are seeing across the country. This burnout is really one of the major problems.

ME: Last month, the US Surgeon General issued an advisory on health care worker burnout. What is the extent of this problem?

Valdez: I have spoken to my colleagues who are still leading health systems, I have had the privilege of serving as a faculty member to train health executives who lead health care organizations across the country. And when I talked to my colleagues and my former students and asked them, what is the number one problem you are trying to solve today? Their answer is always the shortage of personnel, in the face of professional burnout. And of course the financial challenges are also getting their attention because during the pandemic we lost a lot of revenue as many patients were unable to continue their regular services as we were dealing with the increase in pandemic demands. That also brings us to this whole issue of patient safety and concerns. But everyone is really concerned about the employee burnout situation, which seems to be rampant across the country and is the root of much of the reason I say ragged.

Basically, we are a service industry. And we can only serve as many people as we have people to serve. And we can only do that if our healthcare staff maintain their well-being. So I think it’s extremely important that when we think not only about patient safety, we also think about the safety of our staff and the well-being of our staff, because it’s that dyad, the two sides of this dyad must work well, have functioned, for the care to reach its maximum optimal level.

ME: When you were appointed earlier this year, Health and Human Services Secretary Xavier Becerra commented on AHRQ’s essential work to improve primary care. How can the agency do this?

Valdez: Well, what most people don’t know is that our 1999 congressional authorities were to improve health care in America, on health care in its broadest sense, safety, quality, access, even costs. And it is an arduous task. The Affordable Care Act turned around and said, not only do you have to do this, but we have to recognize that primary care and improving the primary care system in our country must be the backbone of building of a high quality healthcare system. health care delivery system. And so, since that time, we have focused both on primary care research, but also on finding ways to help primary care improve in our country. And we went through a number of pilot projects, which are now ready to be scaled up and become national. So one of the projects that we’re looking at, is similar to the agricultural extension program that the Department of Agriculture runs, and to really create a primary care extension program that supports small and medium practices, as well as systems health care delivery organizations that run larger primary care arrangements, so that we can more directly support those practitioners with the new insights gained through the kind of evidence-based programs and evidence generation that we do here at agency, and have a systematic way in which this evidence can be brought into the clinic and into primary care practice. This is one of many ideas we are working on right now, to get federal funding in our next actual appropriations. Because one of the things that is clear is that we have this opportunity to make these kinds of fundamental changes in our healthcare system, largely because of the stresses and strains that the pandemic has placed on our systems of local health care delivery and our primary care.

ME: What didn’t I ask that primary care physicians should know, or what would you like to tell primary care physicians?

Valdez: We pay so much more for our health care, and we don’t get the best quality of care when you compare us to other things going on in the world. And so I think we need to increasingly refocus on what it means to provide high quality care. Care settings have changed dramatically over the past decade. I like to use the example of hip replacements. Previously, hip replacements were performed in hospitals, and hospital stays were expensive and relatively long. Today you can have hip replacement surgery on an outpatient basis and begin your efforts to be ambulatory within the next few hours. And, increasingly, these types of procedural activities are taking place in other settings, and increasingly in outpatient settings, and even in primary care settings. And so increasingly, we have to ask ourselves: what does high quality mean, as we move from different settings of care? Different types of procedures, different types of practices, now take place in long-term care facilities. They unfold as I suggested at home with the example I gave you earlier. So AHRQ is busy trying to understand and trying to anticipate where we are going with the future of health care, especially the future of primary care. What does it look like? What will it be like when we make these video calls and I’m on Mars? Or orbit around a planet somewhere? What future for health in 50 years? We’re trying to get this under control now because if we don’t, we’re going to completely pursue the issues the way we’ve pursued them now. They appear, and then we try to find a solution to the problem far beyond after it has appeared. So we try to anticipate. We look forward to your audience’s suggestions and ideas on where we should go.

Leave a Comment