2003 Recipient Bio

2003 Award Media Coverage

David Lawrence, M.D.
Retired Chairman and Chief Executive Officer
Kaiser Foundation Health Plan, Inc.
Recipient, HRET First Trust Award

August 3, 2003

Thank you, Gail, for your thoughtful and gracious comments. Thank you, Debbie, Mary, and HRET Board members. Thank you, my beloved Kaiser Permanente. And thank you friends and colleagues for honoring HRET and me with your presence and support this evening.

It has been my privilege to be a part of this organization for the past several years, working with its Board and staff and the myriad community representatives associated with its work.

In the past 50 years, our nation has invested…privately and publicly…an estimated $1 trillion in medical research. The products of these investments have enhanced life expectancy, changed lives, allowed hope to replace despair. But these advances have come at a steep price.

Crucial medical advances have been slow to reach the public. In one study, investigators found that the time from discovery or invention to full incorporation into medical practice was 17 years. A study published last month in the New England Journal of Medicine documented that patients receive scientifically appropriate care only 55% of the time; this means that as patients we have an almost random chance of benefiting from the nation’s huge investment in our health.

Equally troubling are issues of safety. In hospitals alone, more people die of avoidable medical errors each year than American soldiers died in the war in Viet Nam. Serious problems in quality, and major disparities in access to health care services by age and race have also been well documented over the past quarter century.

What’s going on? Why do the remarkable advances in medical science move with such difficulty into effective, safe, responsible, equitable, and affordable care for those who need it?

Each advance goes from the researchers, from the pharmas and bio tech firms, from the technology inventors to medical professionals who are free to use them as they wish in a delivery model that has changed little since the turn of the 20^th century. Little research has been done to develop and test new methods for effectively incorporating these advances into daily practice. The innovations in medical science and technology have not been matched with innovations in care delivery. So the costly advances are applied in a haphazard, often dangerous, usually expensive way that is inconceivable in any other sector of commercial endeavor.

Fortunately a handful of organizations are devoted to supporting, finding, documenting, and sharing the scattered islands of innovation in medical care delivery. HRET is one of them. HRET is focused on the linkage between the delivery system and the communities, a part of the care delivery process with special relevance to our nation as we look forward.

Over the next 25 years the number of people over 65, and over 85 will grow dramatically. Similarly, the number of children under the age of 18 is projected to grow rapidly. And 90% of the projected population growth in total population, an added 100 million people, will occur in the nonwhite and immigrant communities of the country.

These trends have significant implications for medical care. The primary work of health care is already the care of chronic illness in the elderly, followed closely by the care of our most vulnerable population—children. That work will increase significantly in the coming decades. Equally important, health care providers will be challenged to respond to the language, education, religions, values and expectations of a society on its way to having no majority population. If we fail to meet these challenges, the value of our nation’s huge investment in medical science and technology will be further squandered, the dangers of misuse will continue to grow, and medical care itself will become too expensive for even greater numbers of citizens than it is today.

Yesterday I gave a speech to a group of health care professionals on the challenges facing medicine. Afterwards, an elderly physician complained to me that many of her immigrant and minority patients lack the family and community support systems to do what was right—healthy—for themselves or their children. They lack the safety net required to get the benefits of advances in medical science.

Researchers at RAND recently documented that the ability of insulin-dependent diabetics to manage their complicated treatment regimens was directly related to their socioeconomic status—their education, their economic status, their integration into their communities.

In a landmark study on successful aging, researchers concluded that the availability of community support systems…church, neighbors, family, transportation, regular social interaction…were directly correlated to better health and greater independence for aging citizens.

This is the work of HRET:

• To help build the safety net for those without the resources that many of us take for granted;
• To help support those with conditions that require sophisticated self-management in order that modern medical science can work;
• To help build the resources and linkages between the aging, the care system, and the communities to enable our growing elderly population to age more successfully and in greater health;
• To help those with chronic and complex illnesses manage their care;
• To help the consumer—patients and families—get the best from modern medicine.

HRET does this by identifying leading practices that create effective care system-community networks and linkages, helping in their assessment, and facilitating the transfer of their experiences to professionals and community leaders alike. It fosters demonstrations and evaluations that test alternative approaches. And it uses its vast connections throughout the health care system and communities across the country to bring leaders together and to promote changes based on demonstrated delivery system-community linkage effectiveness.

This work is vital to our nation’s health, to our nation’s ability to turn our staggering investments in medical science and technology into effective, safe, responsive, timely, affordable, and equitable care for all of us.

I am deeply proud of the honor you have given me tonight because it comes from such special people and such a special organization.

Thank you, members of the Board. Thank you, Gail, Mary, Debbie, and HRET staff. And thank you, friends and colleagues.