On Tuesday we attended an event at the Center for American Progress Action Fund asking whether health reform could deliver providers a system that benefits both clinicians and patients alike (see our live play-by-play on Twitter and video below the break). In the accompanying paper, Health Reform: Delivering for Those Who Deliver Health Care, CAPAF's Mary-Ellen Whelan and the Urban Institute's Bob Berenson argue it can—provided health care professionals are actively involved in shaping the outcome.

Ronald A. Paulus, the event's keynote speaker, is one of those professionals.

As the Executive Vice President and Chief Technology and Innovation Officer, he oversees system-wide innovation at Geisinger Health System (GHS) in Pennsylvania. Along with health systems like the Mayo Clinic, Intermountain, and Virginia Mason, Geisinger is often held up as model for what coordinated, high quality care should look like.

Paulus knows a thing or two about improving the delivery of health care. He talked a lot about how the financial incentives of our current system fail to match our verbalized policy goals, and how GHS integrated model seeks realign those incentives. For doctors, he noted, "It's not easy to be an altruist when you're on the hamster wheel seeing 37 patients a day." At GHS the goal is to get providers off that "hamster wheel" of volume-driven medicine and back to the business of providing the right care at the right time to the right patients. Their integrated system of care—Geisinger is both a health plan and a health network spanning 41 counties in Pennsylvania—allows them to set reimbursement policy in a way that rewards doctors for coordinating care and meeting metrics of quality, such as the ProvenCare model Geisinger's CEO, Glenn Steele discussed with our colleague Joanne Kenen. For elective heart surgery, as the Washington Post noted, Geisinger's model allowed them to effectively offer "a 90-day warranty on elective heart surgery, promising to get it right the first time, for a flat fee. If complications arise or the patient returns to the hospital, Geisinger bears the additional cost."

Paulus gave the audience a vision of what's possible, and in his presentation of CAPAFs paper, Bereson laid out practical principles to build a consensus to reform. Our colleague Meredith Hughes has an excellent summary of paper's key components for delivery system reform. In brief they are:

• Insurance coverage expansion
• Delivery system reform and payment innovation
• Prevention and wellness
• Chronic care management
• Comparative effectiveness

Too often, Berenson argued, clinicians are forced to compromise their clinical judgments because of a patient's health insurance status. Expanding health coverage will allow health professionals to practice their profession.

Likewise, many physicians recognize the need to focus on managing chronic diseases and promoting prevention and wellness, but find their hands are tied by "the tyranny of the urgent." Delivery system reform and payment innovation can help change the that equation, allowing doctors to spend more time with their patients.

That last point struck a chord with the event's discussion panel, which featured representatives from many of the major provider organizations. "Time with patients," said Nancy Nielsen, the president of the AMA, "is perhaps the biggest problem we faced." Her sentiments were echoed by other representatives from the provider community. Frederick E. Turton, the Chair-elect of the Board of Regents of the American College of Physicians (ACP), said studies show that more diagnostics and tests were ordered when physician time was short with a patient and that spending more time with a patient could not only improve quality but help reduce the costs of unnecessary treatment. Diana J. Mason, Secretary of the American Academy of Nursing, called for a renewed emphasis on primary care and better management of the transition from hospital to home, and Cynthia B. Lord, the President of the American Academy of Physician Assistants spoke to need to have incentives for patients as well as providers. And most importantly, they all agree it's time for change.