HJAR Jan/Feb 2023

CHANGING THE WORLD 12 JAN / FEB 2023 I  HEALTHCARE JOURNAL OF ARKANSAS   has become, avoiding harm to patients from care that was intended to help. Let us imagine healthcare that is more effective, using scientific knowledge to provide services to those who will benefit, while refraining from providing services to those who will not. Let us imagine providing patient-centered care that is respectful and re- sponsive to individual preferences, needs, and values. Let us imagine providing care that is equitable and does not vary in quality because of gender, ethnicity, geographic location, or so- cioeconomic status. Let us imagine healthcare that is coordinated rather than fragmented, where teams of caregivers work together to cre- ate and execute a shared action plan that helps patients identify and overcome the barriers, challenges, and obstacles that stand in their way of attaining optimal health. Let us imagine a world where healthcare is affordable to all — each of us as individuals — and collectively as a society, and that doesn’t increasingly con- sume greater than 20% of our GDP with more than $4 trillion in annual medical expenditures. ENVISIONING THE REALITY OF THE FUTURE Consider one small example of an alternative reality where a patient comes in for an initial vis- est form of travel. Television, computers, and the internet created unimagined opportunities for entertainment, work productivity, and global economic expansion. Medical advances helped people live longer and healthier lives. So, de- spite the enormous challenges of the 20th cen- tury, the world, indeed, became a better place. And despite the ongoing conflicts and tra- vails of today’s world, I believe in our ability to respond and adapt to its challenges and to find our way to an even better one. Leaders of the last century collectively faced and conquered one challenge after another — making plenty of mistakes along the way but learning from them and making steady progress toward in- vention, reinvention, and discovery. I also be- lieve in the innate goodness of humanity — of our collective desire to care for ourselves, families, and each other — which is why I am optimistic that despite coming out of our own 21st-century major pandemic, while facing in- flationary economic pressures and the scourge of yet another war, we, too, will make prog- ress toward making the world a better place. I am neither a politician nor a policy expert, but my chosen profession of medicine has a role to play in changing the world. Let us imag- ine a healthcare world that is as safe as aviation History has clearly shown us its propen- sity to repeat itself. Indeed, wars, pandem- ics, and economic hardships have recurred throughout history. And yet, in the words of the ancient Greek philosopher, Heraclitus, “the only thing that is constant is change.” Many people who were born near the begin- ning of the 20th century lived through two world wars, the Great Depression, and a ma- jor pandemic (the H1N1 influenza that killed more than 20 million people worldwide with approximately 675,000 of them here in the U.S.) But they also witnessed the invention of the automobile, airplane, television, and com- puters, as well as the discovery of antibiotics, immunizations, and many other advances in healthcare. The life expectancy of their par- ents and grandparents averaged between 36 and 42 years, while the life expectancy of their children and grandchildren now hovers near 80. Throughout the 20th century, one constant of change was progress. Not only were auto- mobiles invented, but they became safer, more reliable, and faster. Innovations in automobile manufacturing even made cars affordable to the masses, and manufacturing jobs increased economic prosperity. Aviation went from being possible, but incredibly dangerous, to the saf- “Historically, pandemics have forced humans to break with the past and imagine their world anew. This one is nodifferent. It is aportal, agatewaybetweenoneworldand thenext.We can choose to walk through it, dragging the carcasses of our prejudice and hatred, our avarice, our data banks and dead ideas, our dead rivers and smoky skies behind us. Or we can walk through lightly, with little luggage, ready to imagine another world. And ready to fight for it.” — Arundhati Roy in “The Pandemic is a Portal,” Financial Times, April 3, 2020 Kenny J. Cole, MD, MHCDS, is the system vice president for clinical improvement for Ochsner Health in New Orleans. He is a practicing primary care internist with advanced degrees from LSU Health Sciences Center in New Orleans and Dartmouth, as well as executive training from Harvard Business School. Prior to joining Ochsner Health, Cole was the chief clinical transformation officer for Baton Rouge General Medical Center in Baton Rouge, Louisiana, where he designed, developed, and implemented a completely reimagined multidisciplinary team-based model of primary care that focused on aligning clinical with financial outcomes. His current work at Ochsner Health builds on that prior foundation where he is now scaling new care models across the state that specialize in improving health outcomes for older adults. Kenny J. Cole, MD, MHCDS Value-Based Healthcare Correspondent