1. Remarks to the National Association of State Veterans Homes March 1, 2010 Phillip Longman Senior Fellow New America Foundation 1899 L Street, N.W. Washington, D.C., 20036 (202) 986-2700 Longman@NewAmerica.net

2. Assignment: Who is the Jack Welch of Health Care? General Electric CEO and “Manager of the Century” according Fortune magazine.

3. “ The U.S. News & World Report list began in 1990 and Georgetown has claimed top honors since its inception for 11 consecutive years.” Georgetown University Hospital Press Release, 2001.

4. Utilization Rates During the Last Six Months of Life Among Patients with At Least One of Nine Chronic Conditions Receiving Most of Their Inpatient Care from Selected Academic Medical Centers (Deaths Occurring 2001–05) Dartmouth Atlas of Health Care, 2008 Where’s the Science?

5. 000-50-5000

6. The VA: Conceived in Scandal “Colonel” Charles R. Forbes, 1924 World War I deserter, embezzler, imposter, and first director of the Veterans Bureau. Warren G. Harding

7. Tom Cruise’s depiction of life in a Bronx VA Hospital, 1989 Sample dialogue: This place is a f***ing slum!

8. Articles About VA’s Quality “... Overall, VHA patients receive better care than patients in other settings”

10. What is Quality in Health Care?

11. The More Things Change… [Not until some- where around 1911 was it true that] “a random patient with a random disease consulting a physician at random stood better than a 50-50 chance of benefiting from the encounter.” Professor L.J. Henderson (1879-1942) Harvard University 19112004

13. The History of the Hard Hats Deviant Deviant Secretive Secretive Insubordinate Insubordinate Persecuted Persecuted Persevering Persevering Triumphant Triumphant Unsung Unsung

15. “There is no reason for any person to have a computer in their home” ~Ken Olson, President, Digital Equipment Corporation, at the Convention of the World Future Society, 1977.

16. Wally Fort

17. George Timson - 1980

18. “Hard Hat” Greg Kreis

21. Out of the Garage

22. Dr. Kenneth Kizer, accepting 2006 "Leadership in Innovation" award for “the transformational work accomplished while he was at the helm of the Veterans Health System” Dr. Kenneth Kizer, Change Agent

24. Take Home Lessons The VA’s long-term relationship with its patients provides incentives lacking elsewhere in the health care system for investment in prevention, effective disease management, and other metrics of quality. The VA’s collaborative “open source” culture points the way for getting medical professional “buy in” for health IT and its integration into medical practice. The VA’s use of its digitalized records to perform population-level outcomes research illustrates how true, “evidence-based medicine” depends on a large and integrated IT infrastructure. The VA’s quality revolution shows that when it comes to health care, more market competition isn’t necessarily the answer. The VA’s structural liabilities as a government bureaucracy are more than overcome by its ability to integrate care and perform as a true, scientifically-managed system.

25. Phillip Longman Senior Fellow New America Foundation 1630 Connecticut Ave., N.W. Washington, D.C., 20009 (202) 986-2700 Longman@NewAmerica.net