HealthLeaders: How about the biggest disappointment in those four years?
Mostashari: In the movement as a whole, what gives me a little pang every time…is when people say, We don't understand how the stuff you're doing on health IT fits into everything else that's going on around accountable care and new payment and delivery models, and how do these things fit together. I feel like, gosh, I failed, in that this is on me as kind of the communicator for ONC, in terms of having failed to make that connection more clear, because it is absolutely what we're trying to do.
All the discussions have been working backwards from those goals around care coordination, population health, and making sure that people have the tools to do that, and they really do fit together pretty well, but if there's something that kind of pains me is when people still don't see the connections.
HealthLeaders: A lot of people are asking for your advice for the next coordinator. I want to focus on two particular pain points. One is the possibility of a government shutdown and how that would impact the office. The other is just the continuing heartburn that the sequester has caused.
Mostashari: What can I say? I took over as national coordinator on April 8, 2011. It was the day the government was supposed to shut down. So my first act was to assemble all the folks at ONC and talk about the fact that they may need to go home, leave your Blackberrys, and you're not going to get paid until we don't know when. That did not come to pass. We have limped through with continuing resolutions and then sequester cuts without really an ability for the department to rebalance how we budget. Things are frozen at the same relative proportions between initiatives for years. That's like passing a household budget where your kid's in school now, but you still have to keep your budget for diapers. You can't increase your budget for school supplies. It's crazy. But despite that, what I would say to the next national coordinator on that is to lean on the community, and to tap into the desire that everybody has to help us succeed.
Beyond anything else, I think that's been such a gift for us at ONC—the willingness of people in the community to pitch in, to do pilots, to do implementation, to contribute their comments, to make it smarter, to pitch in and participate. But this is hard. Leading a federal agency like this is hard, and that's something that I'm sure the next national coordinator is going to be well aware of.