Documentary Escape Fire inspires innovative action at a critical time

It was just coincidence that CNN aired the acclaimed documentary “Escape Fire: The Fight to Rescue American Healthcare” two days before Group Health unveiled its new ad campaign: “One Goal. Group Health.” But seeing both on TV in the same week reminded me of the tremendous crisis and opportunity now at hand.

The documentary begins with former Medicare administrator Dr. Don Berwick describing Norman McLean’s astounding non-fiction book Young Men and Fire. It was 1949 when 15 Smokejumpers got caught in an inferno near Mann Gulch, MT. Foreman Wag Dodge suddenly stopped and lit a match at his own feet. “I imagine the other firefighters thought the guy was crazy,” Dr. Berwick explains. “But his idea was this: ‘If I burn the fuel around me, when the big fire comes and overtakes me, I’m safe.’” Dodge tried to get the others to join him in the “escape fire,” but nobody did. In the end, he survived, but 13 who tried to outrun the flames died.

“The answer was there, but in the moment some were not able to see it,” says Dr. Berwick. “That’s how embedded people get in the status quo. They can’t recognize an invention when it’s among them. And they can’t give up their old habits.

“We’re in Mann Gulch,” he continues. “Health care is headed for really, really bad trouble. The answer is among us. Can we please stop and think and make sense of the situation, and get our way out of it? It’s the same challenge.”

The movie introduces us to patients harmed by overtreatment, doctors frustrated by a system that reimburses them for sick care but not preventive care, and former industry executives attesting to an entrenched system driven by greed. We meet heroes, too, like the primary care doctor in White Salmon, WA, who struggles to sustain her medical-home practice despite declining reimbursement. A wounded U.S. Army sergeant overcomes opioid addiction. And a Safeway CEO lowers his company’s health care costs by helping his employees stay healthy.

With each vignette—from Dr. Dean Ornish activating patients to take charge of their chronic illness to the Cleveland Clinic physician describing his group’s incentives to keep patients well out of the hospital—I thought: “Group Health does that,” “We’re studying that idea at the Institute,” or “The Cooperative has been doing that for years.” But unlike the movie’s heroes, we’re not exploring just one or two innovations. Because we integrate care and coverage to deliver better health to patients, Group Health has the opportunity to always do best by our patients.

When I saw Group Health’s new ads a few days later, I was inspired anew. “One Goal” tells the whole story: how care and coverage work together to achieve healthier outcomes for patients; and how we have become a national leader by staying true to our founders' mission. Everything we do is aligned around one goal: better health for everyone.

This campaign comes at a critical time in our history. As Puget Sound Business Journal reported on the CNN special’s airdate, Group Health is now laying off many managers. The reason? Even with our integrated system, we’re still too expensive. Our aim is to trim $82 million in 2013 spending, streamlining functions for greater efficiency and making Group Health more affordable. If we fail, many more people in our state will not have access to Group Health’s great care, because they won’t be able to afford it.

This is difficult work, but it’s necessary for the organization to demonstrate its potential. As the Group Health Research Advisory Board discussed at our annual meeting in February, Group Health Research Institute is doing its part, increasingly focusing our research on affordability within our learning health care system.

As Escape Fire ends, Dr. Berwick concludes, “Only by accepting that the American health care system is badly broken, that the status quo is not working, and that it is bankrupting our nation will we be able to seek out the ‘escape fires’ and create a sustainable and patient-centered system.”

Working at Group Health, we have unique opportunities to find solutions to problems of affordability. Let’s use this privileged position to its fullest advantage, identify our own “escape fires” to strengthen the organization and to help save the U.S. health care system. 

—Eric B. Larson, MD, MPH