Roundtables

just moving to a system that will have cost as its only criterion and will try to exclude providers of care and providers of very spe- cialized care that are important in communities? You can imag- ine that when you have high- tech children's hospitals, the cost of care will be higher. But for certain types of care, those high- tech hospitals are where you'll have the best outcomes. A val- ue-based system has to take into consideration both the cost and the quality of the care provided. If it is only focused on cost, then you are not developing a true value-based system. SS: Leaders across disciplines need to focus on chronic disease, socioeconomic determinants of health and workforce develop- ment. It might sound like these issues aren't related, but they are intricately tied to the future success of our country. We are tackling these issues head on because we see them day in and day out in our community. We have community outreach and population health resources ded- icated to moving the needle on chronic disease through wellness initiatives, antismoking cam- paigns, and screening and treat- ment events. We provide access to healthcare to those who need it through a network of more than 170 locations across the re- gion, including the largest school health program in the nation and a home health program. We understand the relationship of poverty and health and work to ameliorate the challenges of housing, homelessness and transportation that our patients experience. As the largest em- ployer in the Bronx, we take meaningful responsibility to sup- port education and job training programs that will fuel the future healthcare workforce. Our efforts cannot stand alone and need to be magnified on a broader scale. We work with our partners in academia, private, nonprofit and government sectors to create a space for this to happen, but more work is needed in these areas. WT: We need to focus on rein- forcing people's personal com- mitments to leading healthy lifestyles and giving them the information and assistance needed to keep them engaged. We need to make sure delivery systems and payment mecha- nisms are modified to provide the right payment and incentives to ensure providers are working with their patients to help them live healthier lifestyles. Current- ly, many payment mechanisms are not structured to provide innovation in the way we take care of patients to help them stay healthy. We will continue to have chal- lenges in healthcare until we have a broader portion of the population actively leading a healthy lifestyle. DW: I do not see any real progress in truly reforming the healthcare system in this country. e PPACA goes aer health insurance reform. at was a necessary step, but we are not reforming the delivery of healthcare and changing the incentives in the system so we can bring costs down and make it more affordable to all people, including patients, governments and employers. What we need to focus on is changing our delivery system and how we finance it so we are more incentivized to keep people healthy and treat chronic disease more aggressively instead of waiting until they get acutely ill. As a country, we have to bring our costs per capita down to where the rest of the industri- alized countries are; not spend double what every other coun- try spends. ere are pockets of success on an experimental basis, but as a country we seem to have no appetite for significantly re- forming the financing and deliv- ery of healthcare. n Top Priorities, Challenges & Innovation in Healthcare 7

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